Can We Really Have A Bipartisan Health Care Plan?

Just in case you were wondering what the public thinks about the recent upheaval over health care reform, a USA TODAY/Gallup Poll taken Wednesday finds some 55% of Americans say President Obama and congressional Democrats should suspend work on the health care bill that was this close to being passed and consider alternatives that would draw more Republican support.

What might these alternatives be? Besides attacking every major Democratic version of reform, the Republicans have been fairly quiet about their own grand vision for the future of health care. Still, there is a vision. At the end of July, the Republican Study Committee, led by Rep. Tom Price (R-GA) (an orthopedic surgeon) introduced the “Empowering Patients First Act” (H.R. 3400) as their contribution to the debate.

The bill, according to the Congressional Budget Office, would have a 10-year price tag of $61 billion. That is far less than the nearly $1 trillion estimate for the Democratic bill that House leaders proposed and far less than the $850 billion estimate for the Senate’s bill.

But the impact of this legislation would be equally meager. The CBO analysis concluded that under the GOP plan, 52 million non-elderly Americans would have no insurance in 2019—even more than the 50 million that will be uncovered by the end of this year. By comparison, the House bill would reduce the number of those uninsured to about 18 million and the Senate bill would leave some 23 million without coverage. According to TPM,  “the GOP bill does require less new government spending, but that's what you get when you don't insure anybody. And though it does reduce the deficit, it does so by billions less than the Democrats' bill does.”

A quick look at the “Empowering Patients First Act” finds no individual mandate for coverage; no mandate that employers offer coverage either. The emphasis is on providing tax credits to help people—including those currently on Medicaid—to buy their own insurance coverage on the individual market. Financing for the Republican plan comes from limiting malpractice lawsuits, cutting disproportionate share payments to hospitals, capping non-defense discretionary spending, and “increased detection and elimination of waste, fraud and abuse in government programs.”

The proposed legislation would require states to offer high-risk pools for people who are hard to insure and would encourage them to create “individual market associations” that would function something like trade groups that already offer a group-like form of coverage for individuals. We already know that existing state-based high risk pools can’t provide affordable coverage for nearly enough of the medically-needy who have no other option. In their report entitled, “High-Risk Insurance Pools: A Flawed Model for Reform,” the Center for American Progress finds:

“High-risk pools have been around for over 30 years and currently exist in 35 states, but they only cover about 207,000 Americans. The biggest barrier to enrollment is cost. High-risk pools are inevitably expensive because all of the enrollees have medical conditions that could potentially result in costly medical bills, which means the pools cannot spread costs across low-risk and high-risk individuals. Despite attempts to cap premium rates, the coverage is still unaffordable for many. In fact, a recent study found that premiums for high-risk pools are unaffordable for about one-third of eligible individuals.”

Here are some details of the current Republican plan, provided by the Kaiser Family Foundation on their site that offers side-by-side comparison of the major health reform proposals:

1) Tax deductions for individuals who purchase their own health insurance. Refundable tax credits of $2,000 for individuals and $5,000 for a family of four with incomes up to 200% FPL for the purchase of health insurance in the individual market.

2) No individual mandate. No employer mandate. Employers may automatically enroll employees in lowest cost group health plan (as long as they allow them to opt out of coverage altogether).

3)  Permit insurers to sell insurance policies across state lines. Prohibit insurers from increasing premiums based on health status upon renewing individual health coverage. Permit insurers who sell policies across state lines to raise premium rates based on claims experience and offer discounted premiums for individuals who participate in wellness activities. Allow individuals whose premiums for individual health insurance exceed the national average premium by 10 percent or more to purchase coverage in another state.

4) Allow employers to vary premiums and cost-sharing up to 50 percent of the value of benefits under the plan, based on participation in a wellness program.

5) Adopt medical malpractice reforms that limit lawsuit rewards and create state health care tribunals to review cases and render decisions.

And finally this edict on the value of evidence-based medicine:

6) Prohibit comparative effectiveness research from being used to deny coverage of a health care service under a Federal health care program and require the Federal Coordinating Council for Comparative Effectiveness Research to present research findings to relevant specialty organizations before publicly releasing them.

Is this what the Americans polled by USA Today meant by wanting to incorporate Republican-friendly proposals into health care reform? These market-driven proposals were bandied about when George W. Bush was President and even then they didn’t pass muster. With no real constraints on insurers to provide affordable coverage to all takers, no expansion of public programs, no direct subsidies to help lower and middle-income Americans pay their premiums, little impact on covering the uninsured and little impact on reducing the national debt, it’s hard to argue that these ideas offer any version of reform at all.

Finally, this is what Ezra Klein had to say about the GOP's leading plan in October and it still holds true today:

“[T]he plan won't work. In particular, its version of the health insurance exchanges will collapse pretty quickly. There's no individual mandate ensuring that the pool includes both healthy and sick individuals, no insurance market regulations stopping insurers from cherrypicking, and no risk adjustment rebalancing the scales when they do. In other words, this looks much like the reforms that collapsed in Texas, and in California. Price isn't learning from past policy mistakes, and so he means to repeat them.”

If Americans really want a bipartisan plan for health care,  they need to put pressure on the GOP to come up with new, thoughtful proposals that will actually help achieve the basic goals of reform: Providing universal coverage while reducing the escalating cost of care. Health care is far too important an issue to trust to policies that dig us further into the current hole we're sitting in.