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 .