ERIC YOLLICK, The Golden Hammer, and ALAN FRAM, Associated Press
WASHINGTON — The House Republican health care law plan to replace the Obamacare failure resembles the original provisions of two great healthcare geniuses: President Ronald Reagan and United States Senator Don Nichols, Republican of Oklahoma. Reagan and Nichols were the primary authors of the original version of HIPAA, the Health Insurance Portability and Accountability Act of 1996. The Reagan-Nichols plan went through Republican precinct, senatorial, and state conventions in Texas during the late 1980s. Republicans consistently endorsed the proposal which ensured insurance portability, eliminated pre-existing condition exclusions, and gave patients privacy. The democrats in Congress repeatedly killed the bill even though it did pass the United States Senate twice.
Instead, after the House GOP electoral revolution in the 1994 election, the Republicans successfully passed a watered-down version of the Reagan-Nichols plan, which became what we know as HIPAA. The problem is that Senator Ted Kennedy (D-Massachusetts) worked with the liberal Senator Nancy Kassebaum (allegedly R-Kansas) to add massive electronic reporting provisions to the medical record portions of the law. HIPAA drove out many older and experienced physicians from the practice of medicine, because those health care providers simply were unable to comply with the provisions of the law which created an electronic “state” in medical care. The liberals in Congress are fighting long and hard now to keep the health care bureaucracy in place.
In 2017, top House Republicans say their outline for replacing President Barack Obama’s health care law is a pathway to greater flexibility and lower costs for consumers. Democrats see a road to ruin for millions who’d face lost coverage and higher medical expenses, particularly the poor.
The plan “ensures more choices, lower costs and greater control over your health care,” according to talking points GOP leaders handed lawmakers heading home to face constituents during this week’s recess.
Democrats say the proposal would threaten the coverage 20 million Americans gained under Obama’s 2010 overhaul. “It’s like rationing” health care, said Rep. Frank Pallone of New Jersey, the House Energy and Commerce Committee’s top Democrat.
The GOP package lacks details, which are a work in progress, and has no estimates of cost or the number of people it would serve. It’s also uncertain if enough Republicans would support it — a hurdle that’s flummoxed leaders over seven years of trying to dismantle Obama’s law.
The plan’s highlights and each side’s views:
MEDICAID: Serves 77 million people, mostly the poor and those with nursing home costs. Benefits go to anyone who qualifies.
GOP lawmakers want states to receive fixed federal sums per beneficiary. These would likely be less generous than today’s payments, which generally cover costs automatically. They’d give more power to states to decide who and which services are covered, and phase out Obama’s expansion for additional lower-earning people that 31 states accepted.
Republicans: The program, which they have long advocated cutting, is unsustainable. Its costs are projected to grow from $390 billion this year to nearly $500 billion in 2022. It’s swamping states, devouring an average one-fifth of their budgets. States should have more freedom to shape programs.
Democrats: The GOP will cut Medicaid’s budget and cash-strapped states can’t make up the difference. That means fewer recipients with higher out-of-pocket costs, dwindling menus of services covered and lower payments to providers.
INDIVIDUAL MANDATE: If people don’t get policies at work or from government programs like Medicare or veterans’ coverage, Obama’s law requires them to buy it privately or pay tax penalties. Millions purchase insurance on online exchanges the statute established, and nearly 9 in 10 get federal subsidies.
The GOP would erase the penalty and phase out subsidies, replacing them with a tax credit for everyone not insured on the job or by government programs. The amount is undecided, but it would be larger for older people and not vary by people’s income. It would cover dependent children up to age 26 and be paid monthly. If one’s tax liability is smaller than the credit, the IRS would refund the difference with a check.
Republicans: Unlike Obama’s subsidies for use on exchanges, the GOP tax credit lets people spend it for any state-approved policies. Adjusting the credit for income like Obama’s subsidies, which are higher for the poor, creates disincentives for work. Consumers would curb medical expenses because they could deposit leftover funds into health savings accounts.
Democrats: A boon to better-off people at the expense of poorer consumers, who today get bigger subsidies than those in higher income brackets. Unlike Obama’s subsidies, the GOP credit is not adjusted for local health care costs.
HEALTH SAVINGS ACCOUNTS: People can already contribute money to these tax-favored funds if they also have health insurance with high annual deductibles. Once the deductible is met, money in the funds can be tapped to pay medical bills. This year’s contributions are capped at $6,750 for families.
Republicans would increase contribution limits, perhaps letting them nearly double. Money could be spent for over-the-counter products.
Republicans: Creates incentives for people to shop for medical care and curb spending, which helps control costs.
Democrats: A gift to the rich. Useless for low- and middle-income families already having trouble saving money. Their savings would pale compared to potential bills for serious health problems.
HIGH-RISK POOLS: More than 30 states tried these government-subsidized funds for people whose pre-existing medical conditions made them costly to insure. They had a problematic history, often losing money and with coverage limits and long waits.
The GOP would create federal grants states could use to help finance pools or any effort to stabilize their insurance markets, like helping people pay premiums.
Republicans: An innovative way to let states design programs to help “their most vulnerable patients,” the talking points say.
Democrats: Historically, the pools get less government money than needed to function well. No substitute for Obama’s mandated individual coverage, fines and subsidies.
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