The New York Analysis of Policy and Government continues its review of the reasons Obamacare had to be replaced.
Government mandates for the inclusion of coverage for treatment modes unwanted and unneeded by many serves to unnecessarily increase costs.
A Cato Institute study notes:
“Like the federal government, all states increase the cost of health insurance by requiring consumers to purchase certain types of coverage, whether or not they want it. Many states require consumers to purchase coverage for services that many consider quackery, such as acupuncture (12 states), chiropractors (44 states), and naturopathy (4 states). Thirty-three states require consumers to purchase at least 40 types of mandated coverage. States have also required consumers to purchase coverage for medical treatments that later proved harmful to health, such as hormone replacement therapy (4 states) and high-dose chemotherapy with autologous bone marrow transplant for breast cancer (at least 1 state, Minnesota). States impose many additional regulations on insurance pools, from premium taxes to rules limiting insurers’ ability to manage utilization. The Congressional Budget Office estimates that, on average, state regulations increase the cost of health insurance by 13 percent. States prevent individuals (and employers) from avoiding unwanted regulatory costs by prohibiting them from purchasing health insurance from states with more consumer-friendly regulations.
Another approach ignored by those who enacted Obamacare was tort reform. A study by the South Carolina Policy Council analyzed the problem. “…medical malpractice tort reform…seeks to obtain a better balance between holding doctors accountable for mistakes and protecting physicians from frivolous lawsuits. In practice, medical tort reform seeks to cap the amount of monetary damages awarded in medical negligence cases. The impetus for this is escalating costs for doctors and insurance companies, on the heels of multimillion dollar settlements to individuals and multibillion dollar settlements to states…Estimates of the cost total of medical malpractice civil cases range from $252 billion (by the Tillinghast-Towers Perrin actuarial firm) to $865 billion by the Pacific Research Institute (PRI). PRI’s estimate includes $589 billion in wasteful spending that accounts for lost future productivity and lost sales ($367 billion) caused by less innovation. While not all tort costs are wasteful — tort law is imperative in a free market system to maintain the rule of law — there is plenty of room for reform…doctors feel they must practice defensive medicine in order to avoid being sued. This practice entails prescribing tests or treatments for patients whose symptoms would not ordinarily require such procedures…Dr. William Jackson, a radiologist at Beaufort Memorial Hospital, says most people would be amazed at how many defensive medicine lab tests are ordered every day.”
As the Republican majority in Congress moves to address the Obamacare crisis, conservatives are asserting that marketplace concepts such as interstate competition, tort reform, and consumer choice in treatment coverage is not being emphasized in the initial phase. GOP leadership is emphasizing a gradual approach, centered around tax credits for purchasing private policies.
The Wall Street Journal reports that “Sen. Rand Paul (R., Ky.) reintroduced… a bill to repeal most of the 2010 health law without replacing it, a measure that cleared the last Congress when President Barack Obama, a Democrat, was in office. Conservative groups view that bill, which Mr. Obama vetoed, as a gold standard. GOP leaders’ decision to back away from that bill now that Mr. Trump is president is causing friction. Sen. Ted Cruz (R., Texas) amplified the message when he left a Thursday afternoon meeting with Senate Majority Leader Mitch McConnell (R., Ky.) and a handful of other Republicans and said the House bill couldn’t pass the Senate and needed to be changed.”
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But Congressional leadership favors a three-part approach, notes the Wall Street Journal. “The leaders plan to first pass the current bill repealing much of the law and offering some Republican-backed elements in their place…The second phase would have Health and Human Services Secretary Tom Price use his administrative power to undo other ACA provisions. The third step would be the hardest—persuading enough Democrats to go along with a set of non-budget health-care bills that would take 60 votes to pass the Senate.Mr. Trump has said letting insurers sell policies in every state would be part of the third phase. But conservatives insist that proposal should be included in the current legislation, since they doubt the likelihood of winning over enough Democrats to pass it.”
Conservatives do approve of portions of the reform bill, reports Townhall, “Compared to Obamacare, GOPCare reduces the role of the federal government in the healthcare system, gives more authority and flexibility to states, spends less, taxes less, regulates less, and coerces less. The individual and employer mandates are gone. Infamous tax hikes like the medical device tax are gone (and in other cases, delayed or reduced). Obamacare’s subsidy system is dismantled by 2020 and supplanted with refundable tax credits for lower-to-upper-middle-income individuals and families, ranging from $2,000 to $14,000 annually…Caps on tax-free contributions to Health Savings Accounts are also raised considerably, almost doubling under this bill. The conservative Republican Study Committee is out with a pretty balanced memo on the positives and negatives of the draft legislation, noting several shifts towards more coverage and more spending over the weekend.”
Some of the very few popular portions of Obamacare would be maintained. “People with pre-existing conditions are protected…Also, lifetime expenditure caps from carriers remain disallowed, and adult children are permitted to remain on their parents’ plan through age 26.
On the other hand, conservatives are concerned that the growth in Medicaid may be unchecked. “Fiscal conservatives opposed the expansion…Obamacare’s status quo would remain in place until 2020, at which point the new law would ‘transition Medicaid into a system in which each state receives a certain amount of money for each of its residents in the program and has more flexibility over how the program functions. That allocation would revert to per person spending levels from 2016 and then grow each year at the rate of medical inflation. However, states would still receive enhanced Obamacare-levels of spending for individuals who were grandfathered in by having enrolled in expanded Medicaid before 2020…Many conservatives want the Medicaid expansion done away with entirely.”
One conservative source, The Daily Signal, emphasizes: “The key problem with the draft House health care bill is that it fails to correct the features of Obamacare that drove up health insurance costs. Instead, it mainly tweaks Obamacare’s financing and subsidy structure. Basically, the bill focuses on protecting those who gained subsidized coverage through the law’s exchange subsidies and Medicaid expansion, while failing to correct Obamacare’s misguided insurance regulations that drove up premiums for Americans buying coverage without government subsidies.”