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Republican Healthcare Proposal Executive Summary : Part 1


Stanley Feld M.D.,FACE,MACE

It is not fair to criticize the Republican Party’s healthcare proposal without providing the reader with the source material. The source material comes from Senator Tom Coburn’s web site. My negative comments should be judged in light of the original proposal. The executive summary follows.

Preventing Disease and Promoting Healthier Lifestyles

· Critical investments in public health and disease prevention will go a long way in restraining

health care costs and improving the quality of Americans’ lives. The Patient’s Choice Act of 2009 would:

Encourage increased coordination of federal prevention efforts and bring long‐overdue accountability to these programs

Require CDC to undertake a national campaign highlighting science‐based health promotion strategies

Equip recipients of Supplemental Nutritional Benefits with easily understandable information about nutritious food options and target the use of food stamps to healthy food choices

Invest $50 million annually for increased vaccine availability and bonus grants to states that achieve 90 percent or greater coverage of CDC‐recommended vaccines

Provide incentives for states to reduce rates of chronic disease like heart disease and diabetes

All of the above proposals should be executed. How will they be implemented? The Republicans do not have a plan but not having a plan does not make the Democrat’s plan a good one.

Creating Affordable and Accessible Health Insurance Options

Our health care system should be easier to navigate and provide integrated care in a more equitable manner. A vibrant market for health insurance that is consistent and fair will allow all Americans access to health coverage.

How will Republicans make a vibrant market for healthcare insurance? How will people who cannot afford healthcare insurance pay for it? The tax credits might help a little. However, if you do not have the cash you cannot pay for the insurance.

The Patient’s Choice Act of 2009 would encourage states to establish rational and reasonable consumer protections, including the following:

Creates State Health Insurance Exchanges to give Americans a one‐stop marketplace to compare different health insurance policies and select the one that meets their unique needs

Gives Americans the same standard health benefits as Members of Congress, so all Americans have a wide range of choices

Protects the most vulnerable Americans to ensure that no individual would be turned down by a participating Exchange insurers based on age or health

What will the premium be for those with preexisting illnesses? Will the premiums be higher for patients with preexisting illnesses? The high risk pool premiums have been very expensive.

Creates a non‐profit, independent board to risk adjust among participating insurance companies to penalize companies that “cherry pick” health patients and reward insurers that encourage prevention/wellness and cover patients with pre‐existing conditions.

Expands coverage through auto‐enrollment at state and medical points of service, for individuals who do not select a plan at the beginning of the year

This is an empty statement. How will this be administered? The devil is in the details and there are no details presented.

Gives states the ability to band together in regional pooling arrangements, as well as the creation of robust high risk pools, reinsurance markets, or risk adjustment mechanisms to cover those deemed ‘uninsurable’

Risk pooling has been tried and has been unsuccessful. It has been an excuse to allow the insurance industry to spread the risk. The proposal also implies variable premiums.

Equalizes the Tax Treatment of Health Care, Empowering All Americans with Real Access to Coverage

Economic analysts across the political divide agree that the tax code is stacked in favor of the wealthy and those who get their health coverage through their employers, discriminating against the self‐employed, the unemployed, and small businesses. The Patients’ Choice Act of 2009 would restore fairness in the tax code and give every American, regardless of employment status, the ability to purchase health insurance by:

Providing an advanceable and refundable tax credit of $2,300 per individual or $5,700 per family

Improving the operation of Health Savings Accounts [HSAs] by allowing health insurance premiums to be paid with HSAs without a tax penalty

Allowing preventative services to be covered by High Deductible Health Plans

Increasing the amount of money an HSA owner may annually contribute to their account

Healthcare insurance premiums are $14,000.00 a year for a family. A $5,700.00 tax credit does not cover it. It also assumes the consumer has enough income to have a $5,700.00 be tax liability. Citizens are not subject to income tax if they make up to $38,000.00 year. HSA’s retain the healthcare dollar to be used for future spending on healthcare. The healthcare insurance industry retains control over the premium and the healthcare dollars. It is not a pro consumer proposal. It does not offer financial incentives to consumers .

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

  • Matt

    Aren’t refundable tax credits for situations in which an individual might NOT have a tax liability? For example, if one makes under $38,000, as you say, they would not be liable for federal income tax. In this situation, then, the “refundable” tax credit as the Republicans propose would be administered to our hypothetical individual without respect to their income. Would he not simply get a check for $2,300 (as an individual)?

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