obamacare alternative

Let's Hope The Republican Health Care Plan Stays In The Basement

Everyone wants to see the Paul Ryan/Tom Price Affordable Care Act (aka Obamacare) replacement bill, even most Republican lawmakers. But Ryan and Price would rather look like a putz than reveal who will be the primary losers under their new plan. They are also afraid that their fellow Republicans will join the media in ripping their plan apart. They have no desire to be once again the objects of a mocking press, Democrats and Obamacare supporters for their inability to present a Republican, majority-supported Obamacare alternative plan.

After embarrassing leaks describing their reform paralysis at the Republican retreat in Philadelphia earlier this year, and the leaked draft that revealed a proposal to base tax credits on age instead of income, Ryan and Price literally went underground (House basement) to reveal their latest proposal to a select group of lawmakers. There's plenty to mock about this childish approach to drafting legislation. But like all things related to Republican health care reform efforts, this latest hide and seek stunt is about politics and not providing affordable health care. Ryan can't keep putting out bad proposals that the rest of the GOP won't support. At least not publicly. He failed in his promise from years ago to lead the effort to draft an Obamacare replacement bill and is now just a mere figurehead of the process. Health care reform is now a Senate and White House effort with Ryan serving as secretary and spokesperson.

And with Senator Mitch McConnell and Secretary Tom Price leading the effort, we can expect more drastic cuts to federal subsidies and fewer people with insurance coverage than if Ryan had pushed through all of his lackluster reform ideas. McConnell has always wanted to push health care reform back to the states via high-risk pools and other disproved policies. But states have made it clear that they need federal government funds and they like the money Obamacare provided. Therefore, I expect the new Republican health care reform bill to grandfather Medicaid expansion for the states that adopted it. And based on past Ryan/Price proposals and the Trump Joint Congressional speech this week, we can easily assume that the crux of the law includes health savings accounts and tax credits that will mostly benefit the well-off, healthy and young Continue Reading...


Can Price And Ryan Con America Into Accepting Less Health Insurance Protection?

It is official, the corrupt and greedy former orthopedic surgeon, Tom Price is the new head of the Department of Health and Human Services (HHS). What changes he will make to the Affordable Care Act (aka Obamacare) weighs heavily on a lot of minds. Will it be a slow dismantling of the law or full replacement? Will he work with House Speaker, Paul Ryan who promises to have a House plan ready in 2017, possibly by the end of the first quarter of the year? At the moment, who knows what he'll do, but expect a lot of noise over the next month from the GOP about their Obamacare replacement plan.

In fact, the show of the Republican's impending replacement plan has already started, with Paul Ryan as its star. First, he hosted a televised town hall in January, trying to convince America that Obamacare was in a death spiral. His criticism of Obamacare continued on the Charlie Rose show, and every other time he is in front of a television camera or reporters microphone. And just this week the American Action Network (AAN), using footage of Paul Ryan and hinting at his BetterWay plan, ran a television ad claiming Republicans have a plan.

After leaks of a clueless GOP grappling with health care reform at the Republican retreat in Philadelphia last month, Paul Ryan is eager to change the narrative. He is building up his party's Obamacare replacement reveal the only way he knows how, by using his star power and telling a bucket full of lies.

Ryan is not as smart as he wants people to think but unfortunately, he has a reputation for being the smart guy that's not afraid of getting into the weeds of policy. He's hoping that his undeserved reputation as technical but empathetic, will allow Republicans to replace Obamacare with less health care coverage. He doesn't frame his proposal as less than Obamacare. Instead, it is referred to as patient-centered and freedom (from costly mandates for coverage you don't need). Continue Reading...


Republicans Need Help "Fixing" Obamacare, We Should Offer Some

Last week's Republican House and Senate retreat in Philadelphia revealed what we already knew; they don't have a plan to replace the Affordable Care Act (aka Obamacare). This week there were reports that some Republicans have given up on repeal and replace and want to “fix” Obamacare instead. Also, this week, shady Congressman Tom Price came one step closer to becoming Secretary of Health & Human Services when the Senate Finance Committee approved his nomination without Democratic support.

It's been a frustrating week for Obamacare supporters concerned about the future of health insurance and health care in America. Every statement about health care reform, even if it is a repeat of what's been said before is scrutinized for new meaning. But for now, we are in limbo, and that is not a bad thing. Things could be worse. We should use this time to put forth some ideas on health care reforml.

Obamacare Could Be Better

Everyone agrees that Obamacare plans could be better—more affordable and there should be more of them. Also, there's majority agreement that some provisions of Obamacare are keepers, like no prohibitions on coverage for preexisting conditions, keeping dependent children on employer-provided plans up to age 26, and receiving subsidies to pay for coverage. But these goodies cost money and require trade-offs. So knowing that Republicans would prefer the government get out of the health insurance business, what suggestions would you give them if they were forced to stay in it. Keeping in mind that you can't get everything you want.

Protests are fine, but how can we improve Obamacare when we know universal coverage is out of the cards in this new Republican reality?

First, agree not to turn Medicaid over to the states via block grant or any other program. States may know their constituents better than the federal government, but equality often comes in a distant second to state budget priorities. We can't trust states to cover everyone who needs Medicaid. We also can't trust them to regulate the quality of care Medicaid recipients receive. Medicaid patients wait longer to see a doctor and get a lower quality of care than patients with private insurance.

Instead of Medicaid block grants or any other state-based Medicaid program, the federal government should run the Medicaid program just like it does with Medicare. Everyone gets the same benefits, and medical providers must meet predetermined quality standards in exchange for higher reimbursement levels.

There is no way for the government, federal or state, to get around paying for health care for the poor. States can assist in this effort by addressing the poverty in their communities, but they should stay out of the health care business for the poor.
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Republican Health Care Reform Plans Are Getting Less Comprehensive And Less Acceptable

To borrow a line from Hamilton, the musical, [Republicans are having their] "governing is harder moment" with health care reform. Just this week they added two more health care reform proposals (outlines) to the seven they conjured up since 2009. The latest health care proposals are near opposites of each other and include an Affordable Care Act (aka Obamacare) light plan and a worse than before Obamacare plan with no subsidies, or possibly, insurance for the sick and poor.

The Road To Still No Health Care Reform Bill

Whenever Obamacare opponents provide an Obamacare alternative plan, its contents are 90% Obamacare is an abject failure, and 10% (usually a bulleted list), here's my plan. Because the focus is not on reforming America's complex and pricey health care and health insurance sectors, their plans come up short in money, benefits covered and access, when compared to Obamacare. This opposition-focused exercise that Republicans are engaged in has produced nine proposals so far.

  • The Obamacare Replacement Act
  • Patient Freedom Act
  • The American Health Care Reform Act
  • The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act
  • Health Care Choices Act
  • A Better Way, To Fix Health Care (Reform Plan)
  • The Patients' Choice Act
  • Health Care Freedom Act
  • Empowering Patients First Act
So, from 2009 to 2017, Republicans have been unable to agree on a unified health care reform plan. But this week they are meeting in my hometown of Philadelphia to map out their policy agenda. According to leaked photocopies of the retreat agenda, there was a Thursday morning session labeled Keeping Our Promise On Health Care. And unless some waiter recorded this session, we probably won't know for some time what Republicans plan to do with American health care. Will they agree on a unified reform proposal—there's no shortage of them, including the two announced just this week? Will they, as Trump mused, wait to see if Obamacare explodes and then "rush" to fix it in 2018, after the mid-term elections? Or will they propose a series of health care reforms stretched out over several years? And will these reforms be more health care or health insurance-centric?

More Words Don't Equal More Coverage

Republicans' Obamacare replacement plans are all over the map. Some focus on health care and health insurance reform together, others one or the other. At first glance, they seem to be growing further apart. But look closer at the latest alternative from Senator Rand Paul, the Obamacare Replacement Act, and you may find several similarities to the plan Congressman Tom Price, proposed in 2009. The Secretary of Health & Human Services nominee, Price, is credited with proposing one of the most comprehensive Obamacare alternative plans, the Empowering Patients First Act. Paul's plan is short on details, but he and Price have the same or similar philosophy about American health care policy. The Acts similarities are notable. For one, both authors are physicians, but the similarities don't stop there.
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The Republican Alternative To Obamacare Always Has And Always Will Be, Personal Responsibility

Trump voters don't like the Obamacare subsidies or the Medicaid expansion because they help the undeserving. Consequently, they are okay with repealing and replacing Obamacare with something better, and they believe Trump can provide it because he is a businessman. Yeah, they believe that. And while I play around with the idea that Trump will surprise Republicans by proposing single payer health care so that he can brag about accomplishing something President Obama could not, the realist in me expects a plan similar to the alternative "plans" already offered up by Republicans. And the overarching theme of all of these plans is, personal responsibility and nothing says personal responsibility like putting aside your money to pay for your out-of-pocket health care expenses. You don't need subsidies. You just need a good tax deal to help you better use the money you should have. And that's why Republicans love health savings accounts (HSAs) so much.

Health savings accounts (HSAs) allow individuals to set aside money in tax-favored accounts to pay for medical care and prescription drug expenses. So, in addition to paying health insurance premiums, deductibles, coinsurance and copays, you can put some "extra" money in a tax-free HSA account. Think of HSAs as the health insurance version of the 401(k) retirement savings plan. Before 401(k) plans, employers provided pension plans to workers and their retirement benefits were pretty much guaranteed. Employers typically financed these plans but some plans required small employee contributions—it was an employer responsibility or a shared responsibility between the employer and employee. Then came the 401(k) plan with its risk of losing money, high finance fees, and employee-only or employee-mostly contributions. Responsibility shifted.

And how has the retirement income responsibility shift worked out? Well, just the other day, the Wall Street Journal reported that many supporters and early adopters of 401(k) plans acknowledge that they were mistaken in its benefits. Continue Reading...


Paul Ryan's Elitist Health Care Plan May Have Some Appeal

Paul Ryan and the Republicans in the House have taken a beating in the media for their impotent Affordable Care Act (aka Obamacare) alternative plan. The criticism is warranted. After so many years of promising to produce an alternative to Obamacare, the best the Republicans can provide is an outline of a policy. Yet there is learn a lot we can learn from Ryan’s proposal. We can learn about Ryan’s personal views on life and health.

Paul Ryan’s Obamacare alternative was written from the perspective of a healthy and fit person who expects to stay that way.

  • If you are really sick and traditional health insurance companies don’t want to insure you, Ryan’s sympathy is with the health insurer.
  • If you have a serious health condition requiring lots of medical care, healthy people should not have to subsidize your health care expenses. You should be forced to maintain continuous coverage, at a higher rate, pooled with other seriously ill people.
  • If you are currently active and healthy, you should have a policy tailored to your individual health. If you want a skimpy health plan, you can have it.
  • If you are currently healthy, you should receive tax credits (or portable payments) that you can save until you need it or use it to pay for dental or vision care.
  • If you can afford to set aside thousands of dollars to pay your medical expenses, you should be able to do so with tax-free dollars in a Health Savings Account.
There’s no denying that Paul Ryan is a health and wellness elitist. He has no empathy for people who are ill through no fault of their own. He thinks health status is a lifestyle choice, just as he thinks poverty is a lifestyle choice. Health status is a lifestyle choice for some, but certainly not everyone. Ryan can’t see beyond his face in the mirror to draft a national health care policy that addresses the diversity and complexity of the American health care system.

Buuuut… If you are healthy like Paul Ryan, it’s not hard to find his Obamacare alternative plan appealing. Continue Reading...

Employment-Based Health Insurance Supporters Should Get Out Of The Way Of Health Care Reform

By all accounts, and there are many, employers are committed to providing workplace health insurance for the foreseeable future. For them, offering coverage is purely an issue of competitiveness. The primary purpose of providing coverage is to attract and retain workers. Period. End of Story... Having a happy and healthy workforce was never a stated goal. However, it appears their selfishness is catching up with them and they know it. Even their traditional allies are questioning the benefits of continuing the health insurance access status quo.

Republicans Challenge Tax Status of Employment-based Health Insurance

Republicans in Congress and the Senate are rethinking the favorable tax treatment workplace health insurance plans currently enjoy. With the urging and free counsel of several conservative intellectuals, Republicans are adding language to their many Obamacare alternatives that would reduce, cap or eliminate these tax advantages. A
proposal, Empowering Patients First Act, from U.S. Representative Tom Price would provide tax credits to everyone purchasing individual coverage and cap the tax benefit of employer-provided coverage. An earlier republican proposal, the Patient C.A.R.E. Act, also calls for “reform” of the tax treatment of employer sponsored health insurance coverage to pay for tax credits provided to individuals who purchase coverage. And the latest proposal from the Republican Study Committee, American Health Care Reform Act, would eliminate the tax-favored status of employer-based health plans. The plan would instead provide a tax deduction to individuals and families to pay for health insurance.

If it looks like Republicans are looking to shake up the world of employer-sponsored health insurance, it is because they are. But let’s not give them too much credit because Obamacare already has a provision to limit or cap the tax benefits of workplace health insurance—the Cadillac tax. Ironically, many republicans want to repeal this tax. Even Representative Tom Price has called for repeal of the Cadillac tax before he put forth his proposal to offer something similar. Go figure.

Groups Defend Health Insurance Access Status Quo

Still, don’t expect businesses and the lobbying groups to take this sitting down. Trade groups, professional associations, insurers, brokers, human resources and benefit professionals will more than likely resist any changes to the workplace health insurance status quo. They will boldly claim the current system works and it is what workers prefer. Oh, yeah, they already claimed that. They will also claim that they support efforts to increase access to affordable health insurance to the unlucky millions who do not have workplace health insurance, and they’ll leave it at that.
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What Does Being "Lazy" Have To Do With Health Insurance? Nothing.


Yesterday one of the kindest individuals I know made some horrible comments implying Obamacare favors the "lazy" at the expense of the motivated. He does not think it fair that the rest of us should pay for health insurance for these "lazy" individuals. As if not being able to afford the high cost of health insurance means you are lazy.

Unfortunately, this is the typical argument of the uninformed or those with a vested interest in maintaining the status quo. He was a member of the former group (but currently informed and reformed). But it is the latter group who was clearly shaping his opinions about who is "entitled" to healthcare in America. Even though these individuals have been wrong about nearly everything they said would happen under Obamacare, they continue to repeat their distortions. Obamacare has not:
  • Caused employers to lay-off millions of workers
  • Increased the costs of health insurance above previous trend levels
  • Created death panels, etc.
Facts mean nothing to these angry opponents of Obamacare. Instead of railing against over priced medical care or wealthy doctors and health insurers, they direct their anger at the poor. But maybe I'm giving these folks too much of my time. Only a change of heart can change their opinion about Obamacare, because factual information sure isn't working. So let's just leave these curmudgeons to their indifferent beliefs. They have little to no power to change the direction of Obamacare.

I’ll save my disdain for the uncaring and self-interested politicians and their ilk that do have the power to make changes to Obamacare—like the newly announced candidate for President of the United States, Ted Cruz. It wasn’t until yesterday when I read “the comments” and learned of Cruz’s announcement that I started to think about what American health care would look like under a Cruz White House. Until then the only thing I knew about Cruz’s stance on health care is that no one in the world wants to repeal “every word” of Obamacare more than this guy. (Well, maybe a few conservative intellectuals who would rather set themselves on fire than live in a world where a law enacted by President Obama defines the nation for years to come… But I digress.)
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