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.

Second, make wealthy seniors pay more for health insurance and medical care. Medical bankruptcies are a real problem in America, which is a national disgrace. But seniors hoarding their cash to pass on to the next generation while the government pays most of their health care expenses is also a problem. Sure, we all pay Medicare taxes, but wealthy seniors should pay more for the care they receive because they can afford it. Wealthy seniors already pay a higher Medicare Part B premium. We should lower the income (including investment income) threshold for this higher premium (for example, from $85,000 to $60,000) or increase the premium amount. Wealthy seniors should also pay higher copays for medical care.

Third, eliminate the favorable tax treatment of employment-based group health plans completely--no more unequal subsidizing of health insurance premiums.

Fourth, provide federal subsidies to help pay up to 50% (dependent on income) of private health insurance premiums. No subsidies for single individuals with incomes of $75,000 or higher and married couples with incomes of $150,000 or higher.

Fifth, provide federally funded health savings accounts of $500/year for the first three years for people receiving federal subsidies. Recipients can use accounts to pay premiums, copays, deductible and coinsurance for qualified medical care expenses. Allow all private health insurance purchases to fund an HSA; however, limit the tax-free benefits to a lifetime cap of $5,000 for individuals and $10,000 for couples not eligible for a subsidy. (This lifetime cap applies even if income changes after the individual makes their first contribution to the account).

Sixth, continue the prohibition against denying coverage for preexisting medical conditions but lower the age of dependents eligible to remain on their parent's health insurance plan from age 26 to age 24. Parents will probably drop their dependents once employment-based plans lose their government tax subsidies.

Seventh, require hospitals, medical care providers, and drug makers to charge the same price for the same care, products, and services regardless of the type of insurance or lack of insurance.

Eighth, keep the Obamacare individual mandate but increase the amount to the equivalent of the lowest cost health plan in the area.

My health care reform plan is not complete, but I'll keep working to improve it. It is also an expensive plan because health care is expensive. Until our representatives get serious about addressing high health care prices by making the tough decisions on how much medical and drug innovation we can reasonably afford, they need to provide significant financial support to people buying health insurance and health care. Also, unless we lower medical care prices, we can't afford to subsidize the health insurance cost of the wealthy regardless of where they live. Let the states decide if they want to subsidize the health care cost of people in high cost of living localities.

Health care reform is tough.

Tags: obamacare, obamacare alternative, obamacare subsidies, Medicare, Medicaid