At today’s House Republican retreat, President Obama emphasized the Republican ideas in the House and Senate health care bills and called on the party to abandon their harsh rhetoric and work on reform in a bipartisan manner. “[F]rom the start I sought out and supported ideas from Republicans, I even talked about an issue that has been a holy grail from a lot of you and said I would be willing to work together as part of a comprehensive package to deal with it. I just didn’t get a lot of nibbles,” Obama said before listing 3 or 4 Republican policies that are part of both health care reform bills.
During the question and answer session, however, the GOP still insisted that all of their ideas had been ignored. Rep. Tom Price (R-GA) — who just this summer engaged in a misleading campaign to trick physicians into opposing health care reform– accused Obama of “repeatedly” saying “that Republicans have offered no ideas and no solutions” and touted the health care solutions offered at GOP.gov. House Minority Leader John Boehner (R-OH) even provided the President with a book of GOP solutions.
So what do these ideas entail? Like Democrat proposals, Republicans solutions would prohibit health plans from setting arbitrary annual or lifetime spending caps, eliminates rescissions, allow insurers to sell policies across state lines, and require insurance plans to cover dependents up through their 25th birthday. The Democratic health care bills incorporate some of these ideas in modified form. As Obama explained of the “across-state-lines” idea, “we include that as part of our approach. But the caveat is, we’ve got to do so with some minimum standards, because otherwise what happens is that you could have insurance companies circumvent a whole bunch of state regulations about basic benefits or what have you, making sure that a woman is able to get mammograms as part of preventive care, for example.”
Republican solutions promise to “take meaningful steps to lower health care costs and increase access to health insurance coverage” “without (1) raising taxes; (2) cutting Medicare benefits for seniors; (3) adding to the national deficit; (4) intervening in the doctor-patient relationship; or (5) instituting a government takeover of health care.” In short, Republican solutions take small steps towards regulating insurers, but do very little to lower health care costs for sicker Americans or control overall health care costs. In practice, their policies simply shift the costs and risks of insurance onto individuals and fragment the insurance market into low-cost plans for the healthy and high-cost insurance for the sick. Below is a summary of the plan House Republicans introduced in the House:
Access to coverage:
– Establishes high risk pools for sicker individuals: State are required to establish high risk pools for Americans who cannot purchase insurance in the individual market due to pre-existing conditions, but nothing in the legislation prohibits the state pools from excluding coverage for the very condition that makes an individual eligible in the first place (as they do today.) The bill abolishes waiting lists and specifies that the pools must provide at least two coverage options, one of which must be a high deductible plan with HSA. Premiums can be set at no higher than 150% of (state) average. The federal government will provide $15 billion in funding.
- Healthier Americans can purchase coverage on the individual market: For Americans moving from group to individual coverage, the legislation eliminates the HIPAA requirement of having creditable coverage in the past 18 months to receive individual insurance market insurance. Annual or life time spending caps are also eliminated. However, the bill will allow insures to deny coverage for pre-existing conditions and charge very different rates based on gender and age.
- Health insurers can sell policies across state lines: The insurer only has to follow the rules of the state it declares to be its “primary” state, not of secondary states in which it can also sell policies. As a result, all policies will have a ‘buyer beware’ label warning consumers that the plan is “not subject to all of the consumer protection laws or restrictions on rate changes of the state.”
- Businesses can form association health care plans: The legislation creates rules for governing association health plans, which will allow small businesses to come together, by industry or trade, and form health plan through which they can purchase coverage for their employees. Association health care plans have sole discretion in selecting specific items and services that can be included as benefits (i.e. no minimum guaranteed benefit package, or minimum costs etc). The plans are to be operated by Board of Trustees who appoint the actuary to determine financial status and viability.
Lowering health care costs:
- Offers bonuses for states that lower premiums, number of uninsured: Establishes state innovation program grants to reward states for lowering the cost of their premiums. Includes bonus for reducing the number of uninsured.
- Establishes a plan finder website: States contract with private entities to create a health “plan finder” website which do not directly enroll individuals in insurance plans.
- Malpractice reform: Specifies that claims must be filed within three years, and caps non-economic damages at $250,000.
- Enhances Health Savings Accounts: Enrollees can build their credit by contributing to their HSA and can use HSAs to pay for high deductible plan premiums. The bill extends the definition of a qualified medical expense.
- Employer wellness programs: Allows group and individual health plans to vary premiums and cost-sharing by up to 50% of value of benefits based on participation or lack of participation in a standards-based wellness program.
- Federal dollars can’t touch plans that offer abortion coverage: The bill does not allow federal funds to go to any insurance plan that offers abortion coverage. This means that a woman who wants to purchase a comprehensive health insurance plan would have to pay for the entire cost of the policy, even if she qualifies for subsidies and uses private premiums to pay for her abortion.