Starting today, insurance companies can no longer discriminate against children with pre-existing conditions, drop coverage because of a simple mistake on an application, institute lifetime caps, limit choice of doctors, charge more for emergency services obtained out of network, or levy deductibles, co-payments or co-insurance for certain preventive benefits. Children will also be able to stay on their parents’ plans until their 26th birthday and everyone will have the right to appeal insurer decisions to an independent third party.
Ironically, today Republicans are also unveiling a new ‘Pledge To America,’ an agenda which promises to “repeal” all of these benefits — as well as the entire health care law — and replace it with “reforms that lower costs for families and small businesses, increase access to affordable, high-‐quality care and strengthen the doctor-‐patient relationship.” The document provides almost no specifics about what the party would do to control health care spending, improve quality, or pay for its reforms. And at least 7 of the GOP’s ideas on health care are already included in the health care law:
|Affordable Care Act||GOP’s ‘Pledge To America’|
|Insurance Across State Lines||Allows for the creation of State Health Insurance Compacts – permits states to enter into agreements to allow for the sale of insurance across state lines. (SEC. 1333; p. 100-101)||“We will allow individuals to buy health care coverage outside of the state in which they live. ” (p. 15)|
|High-Risk Insurance Pools||The states and the federal government have already established high-risk insurance pools to provide temporary coverage to individuals with pre-existing conditions until 2014. (SEC. 1101; p. 30-33)||“We will expand state high-‐risk pools, reinsurance programs and reduce the cost of coverage” (p. 15)|
|Pre-Existing Conditions||Children cannot be denied coverage starting today, but beginning in 204, insurers must accept everyone who applies. (SEC. 2702-2705; p. 46-51)||“We will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a pre-‐existing condition.” (p. 15)|
|Lifetime and Annual Caps||A health insurer cannot impose lifetime limits and will be prohibited from placing annual limits on plans beginning in 2014. (SEC. 2711; p. 14)||“[E]liminate annual and lifetime spending caps” (p.15)|
|Recissions||A health insurance issuer cannot rescind a policy except for in cases of fraud. (SEC. 2712; p. 14)||“[P]revent insurers from dropping your coverage just because you get sick.” (p.15)|
|State Innovation||States can receive waives from certain requirements if they can cover the uninsured and lower health costs in a more innovative manner. (SEC. 1332; p. 98-100)||“We will incentivize states to develop innovative programs that lower premiums and reduce the number of uninsured Americans.” (p.15)|
|Conscience Protections||The law does not affect existing conscience protections or discriminate “on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion.” (SEC. 1303; p. 67)||“We will also enact into law conscience protections for health care providers, including doctors, nurses, and hospitals.” (p.15)|
The document doesn’t detail how Republicans plan to offset the $140 billion deficit increase that will result from repealing the ACA or how they’ll lower health care spending. The Congressional Budget Office estimated that the GOP’s previous very similar health care plan — presented by House Minority Leader John Boehner (R-OH) as an alternative to the House health care bill — would increase the number of uninsured to 52 million in 2019 and reduce the deficit by only $68 billion over the 2010–2019 period.
Moreover, as conservative health care blogger Avik Roy points out, “the Pledge says almost nothing about the biggest and most difficult questions in health policy: Medicare and Medicaid reform.” “It criticizes PPACA’s ‘massive Medicare cuts’ without offering an alternative solution for putting the program on stable long-term footing.” CMS estimated earlier this month that under the health law, Medicare spending will decline $86.4 billion from previous projections due to reforms. “Specifically, average annual Medicare spending growth is anticipated to be 1.4 percentage points slower for 2012–19 than we projected in February 2010. By 2019, it is projected to grow 7.7 percent—0.9 percentage point more slowly than we projected in February 2010,” the report concluded. Repealing the law would increase in Medicare spending. How do the Republicans plan to hold down those costs? On that their document is absolutely silent.