The GOP touted last year their replacement plan for the Affordable Care Act, aka Obamacare, with their version titled, “Patient Care, Affordability, Responsibility and Empowerment Act.” With this article being over a year old, the hyperlink providing reference to the Patient CARE Act returns an HTTP 404 error. However, the basic tenets of the Republican plan are contained in the article as well as the source from McClatchy DC.
While listening to Herman Cain this morning, he reported the Republicans have rolled out a plan, part of Paul Ryan’s six part policy agenda, to address the failure of Obamacare and “replace” it with a more palatable Republican alternative. Simply put, as it was in the case of Obamacare, the Constitution for the united States of America does not enumerate power over healthcare insurance, the healthcare industry or healthcare period to the federal government. Any “replacement” is still in violation of the Constitution.
As the Washington Post reports:
Uniting around a healthcare alternative has proven tricky. While various Republican lawmakers and conservative thinkers have proposed pieces of an Obamacare replacement, the GOP-controlled House has had more success rallying around the “repeal” part than the “replace.”
Republicans have vigorously attacked Obamacare since its passage, citing its costs, its effects on the health-insurance market and its toll on the economy. Their opposition culminated in the two-week federal government shutdown in 2013 [debatable], and repealing and replacing Obamacare remains at the center of GOP campaigns across the geographic and ideological spectrum.
“Obamacare simply does not work,” the new proposal reads, according to a copy distributed to reporters ahead of Wednesday’s launch. “It cannot be amended or fixed through incremental changes. Obamacare must be repealed so that Congress can move forward with the kinds of reforms that will give Americans the care they deserve.”
True enough, Obamacare does not work, has not worked and is intended to fail. However, as many have said all along, it cannot be fixed or amended incrementally; Obamacare has to be fully repealed without a replacement and get back to insurance as it was prior to this debacle. Any replacement, regardless of political party, still has government usurp authority. One has to be leery of the word “reform” since any “reform” coming out of Congress has never bode well for the American public.
The Post continues:
Developing a comprehensive alternative requires engaging in difficult trade-offs to balance the Republican goals of decreasing costs and deregulating the insurance market against a potential decline in coverage rates and the demise of popular Obamacare provisions like ending insurer denials for “preexisting conditions.” It would also require submitting any proposals for a nonpartisan cost estimate from the Congressional Budget Office, potentially exposing significant long-term costs.
The new plan does not include any price tags but rather resurfaces ideas that have long been discussed in Republican policy circles.
A senior House GOP leadership aide who briefed reporters on the proposal Tuesday compared the document to the “white paper” issued by then-Sen. Max Baucus (D-Mont.) days after Obama won the 2008 election that formed the blueprint for what became the Affordable Care Act.
“It’s a framework,” the aide said, explaining that the nitty-gritty of a GOP health-care plan would be hashed out by the relevant committees. “It is laying the groundwork for what the Congress and House Republicans can do next year through the committee work.”
The anonymous aide stated that while Obamacare focused on expanding coverage to Americans, the GOP plan focused on “lowering health care costs and expanding choices for individuals and employers.” And, how does this Republican plan propose to lower health care costs and expand choices for individuals and employers? It’s a question that should be answered thoroughly if the GOP is intent on continuing to violate the Constitution keeping the hand of government in health care insurance and the health care industry. One way to “lower health-care costs” is through the “rationing of care” – denying certain services to a particular segment of the population. Another avenue is to control the prices health care providers charge for services or to limit in-patient stay coverage, etc.
Basically, the GOP plan attempts to discard the central components of Obamacare: individual and employer mandates, tax subsidies to help citizens to afford coverage, expansion of Medicaid, dissolution of the federal exchanges, and national coverage standards. Several proposals comprise the Republican plan.
– A refundable tax credit for Americans who do not have employer provided insurance coverage. Similar to the subsidies under Obamacare, individuals would not be subjected to income limits, would not be mandated to purchase through exchanges and allowed to purchase a wider variety of plans that would include low-cost, low-benefit “mini-med” plans Obamacare phased out of the market.
Under the previous GOP proposal, “‘states would be given new tools and authorities to help their citizens and manage their costs.’ Under this plan, the states would be allowed to default enroll individuals who have health care tax credits but fail to make a health care plan choice. However, individuals may change plans or choose to opt-out of coverage entirely if unhappy with the state’s assignment of a default plan.”
It is unclear with the new GOP plan if this “state directed” authority remains in place.
– Expand the use of private Health Savings Accounts or HSAs. Many alternatives to Obamacare pair tax-free HSAs with high-deductible plans. The GOP plan contends this model “helps patients understand the true cost of care, allows them to decide how much to spend, and provides them with the freedom to seek treatment at a place of their choosing.”
Individuals have always had the freedom to seek treatment from a place of their choosing. However, insurance may not always cover the cost if the provider is not within the network. Yet, individuals can still choose to be treated at their provider of choice by paying out of pocket.
Controversy remains regarding the use of HSAs. Proponents contend HSAs are an important reform that will help reduce the rising cost of health care and increase the efficiency of the healthcare system. Opponents claim HSAs could worsen the health care system because individuals may defer use of the HSA for services that could be covered by the HSA or spend it frivolously because it has accumulated and avoid the penalty taxes for withdrawal of the funds. Moreover, individuals who have health issues with predictable costs may avoid HSAs to have the cost reimbursed by insurance.
– Allow insurance companies to charge young people less and older people more. Under Obamacare, insurers could charge older participants no greater than three times the amount charged to younger individuals for the same plan in the same state. Republicans claim that the three to one ratio is unrealistic. Instead, the GOP plan proposes to charge older participants five times as much as younger individuals to “better align premiums with cost.”
Take two participants, one at age 20 and the other at age 60. The 60-year-old participant has no health care problems, takes no medication daily, sees the doctor when sick or for a yearly physical and health screenings, and does not drink or smoke. The 20-year-old participant, on the other hand, has multiple health care problems, takes several medications daily, sees the doctor routinely for monitoring and health care management as well as for routine physicals and health screenings, and does not drink or smoke. According to the GOP plan, similar to Obamacare, the healthy 60-year-old would pay five times the premium for the same coverage as the chronically ill 20-year-old. Based on this scenario, who is the higher risk for increased health-care cost?
Granted, it is possible the older participant, in general, may cost more at a later time, if the older individual develops significant health problems. However, when looking at the number of years covering the younger versus the older participant in this scenario, who actually would cost more over the terms of the policy? It is difficult to say since health status is ever changing. It is still questionable whether charging older participants more based merely on age is appropriate.
– Funnel the costliest patients to subsidized “high-risk pools.” Obamacare relied on mass participation in this health care insurance program so that premiums paid by a broader number of healthy subscribers would cover the costs or subsidize that of the sick. Many healthy Americans chose not to buy health insurance, which is their right and choice. Because of this, insurance companies denied coverage to sick participants or elevated the premium to unsustainable levels. According to the GOP plan, the problem is solved by establishing “state-based ‘high-risk pools’ for the sickest” and appropriating $25 billion in federal support over the next ten years.
And, from where will the $25 billion in federal support over the next ten years come? Get out your wallets taxpayers. There is some controversy on the effectiveness of “high-risk pools.” If you are unsure what a “risk pool” is, this helps explain it. The National Association of Health Underwriters (NAHU) provides a consumer guide to “high-risk pools.” Still, this does not seem to be an optimal solution for these particular individuals.
– Restructuring Medicaid and Medicare. The plan includes Medicaid and Medicare reform proposals that have been circulating for years — most prominently, in the federal budgets Ryan proposed as House Budget Committee chairman. Medicaid funds would be handed to the states either as block grants or as per-capita allotments. Medicare, meanwhile, would move toward a “premium support” model where seniors would choose a private health plan, and Medicare would pay at least a portion of the premium. The plan does not describe cuts in coverage, but these proposals have been previously floated in the context of long-term federal spending reductions.
Obviously, these politicians at the federal level are not aware of the rampant Medicaid abuse and fraud by beneficiaries and providers, the “good ole boy” network of State politicians in gaining constituents Medicaid coverage in excess of the limitations of that coverage, qualifying individuals for Medicaid coverage who in actuality do not qualify, covering of individuals who are not citizens, and a host of other corruptions at the State level regarding administration of the Medicaid program. Medicaid is a politically charged and influenced program in many states, meaning legislators and the politically connected pull strings with those employed in the agency administration responsible for the program for either constituents or providers.
Medicare, like Medicaid, is riddled with issues including fraud and abuse. The fraud and abuse, as well as offering these programs to individuals who should not qualify, has not been addressed by the GOP plan. Moreover, whether cuts will be made to these programs is not clear despite being considered in the past.
Still, after all this time, neither the Republican Party nor the Democrat Party gets the picture. Any government assumption of authority over health care, health care insurance and the like is outside its enumerated powers established in the Constitution. Yet, regulations on interstate commerce regarding sale of health care insurance across state lines, even if only done regionally, are not considered to be revised in order to let the private marketplace work. The only solution, since Obamacare was shoved down the throats of Americans, is continued government hands in the health care industry pot through repeal and replacement with Republican options, according to those in the federal government.
If you read this proposal by Republicans and compare it to proposal covered in the article in February of 2015, not much has changed. However, the 2015 proposed CARE Act contained an option that would allow “small businesses to pool together to negotiate small business plans and states could utilize an interstate compact in order to allow purchase of insurance plans across state lines.” Still, as in 2015, Republicans have not offered a plan to correct or attempt to reverse the damage already caused by Obamacare. Moreover, the costs involved in “revamping” the health care insurance industry from Obamacare to the Republican repeal and replace option has remained elusive. Of course, that will have to come from the Congressional Budget Office, which could expose significant long-term costs.
As stated in the 2015 article:
Nothing has been mentioned about the change in recommendations regarding mammograms, colonoscopies, etc., that have been issued under the current health care insurance monstrosity nor has any mention of the reversal of rationing of health care been addressed. This “proposal” ignores the Independent Advisory Payment Board that received so much attention when it was implemented with Obamacare.
For some reason, politicians have concluded that no one should be without health care insurance. What did Americans do before that market came about? What did Americans do before health care insurance coverage moved from “catastrophic coverage” to “comprehensive coverage?”
Unemployed individuals earn zero dollars, which mean these individuals have zero dollars for health care insurance. These individuals could not even purchase a plan under Obamacare nor under any other “repeal and replace” option. Why do Republicans think this will be any different under their plan? Is it possible unemployed individuals could receive “tax credits” to purchase health care insurance plans? If these individuals receive credits to purchase health care insurance, how do these individuals pay for co-insurance amounts and deductibles without income?
Just like Obamacare, the GOP plan, framework or proposal will still leave many without health care insurance coverage. Only a “single-payer,” government run and sponsored health care insurance system will cover all citizens regardless of economic status. Our elected officials have decided it is “government’s job” to provide care and security for the populous. In order to do that, elected officials and those in government expect citizens to give up individual liberties and freedoms for the benefit of the collective.
The best way for anyone to have health care insurance coverage is through a job – employer benefits. Why has no one discussed mechanisms to encourage the return of corporations and industry to America in order to provide jobs that would offer health care insurance as a benefit? Why has no one discussed the hiring of illegal alien invaders over Americans or requiring Americans to speak a language other than English in order to attain a job?
Another unidentified Republican aide stated the address of any dynamic effect of the plan cannot be done until the committees start to legislate. In other words, a group of politicians who have no idea about the health care industry, health care insurance and who are in the pockets of Big Pharma and Big Insurance are going to go into committee to “legislate” or propose legislation on health care insurance. Does anyone not know where this will go? It is slated to be “Obamacare Lite.”
Where are the hospitals, doctors, nurses, therapists, and other health care professionals in working to develop solutions for their own communities to address gaps in health care and health care insurance? It is the people on the front lines of health care and consumers who best know what the problems are and how to address them in their area. This nation is not “one size fits all” where a piece of legislation good for New York City is good for Donaldsonville, Georgia, when it comes to health care solutions. Where the government fits in revolves around the regulation of interstate commerce – buying and selling of goods/service across state lines, i.e. health care insurance.
Regardless of any solution, the hard cold fact remains that many individuals will not have health care insurance either by choice or by circumstance. Remember, God-given unalienable individual rights does not cover health care insurance as that is a creation by man. And, for those who cannot afford health care or health care insurance, the health care professional community needs to provide more charitable clinics accessible to individuals in all areas, urban as well as rural. In some instances, medical professionals could offer “alternative” free-market, physician owned and managed facilities, such as the Surgery Center of Oklahoma, and physicians who charge patients a set monthly fee for access to services.
Are we to understand the government is better at drafting solutions than health care professionals? No way as the bundled pricing “unintended consequences” under Medicare is a prime example. Another SCO video and informative article shows a graph of the “rate of rise of healthcare spending in the United States over time, the rate of rise of the number of administrators in healthcare over time in the United States, and the rate of rise of the number of physicians in the United States over time.” Since 1990, it appears the rising cost of health care can be attributed to the rate of rise of the number of administrators in healthcare over time. Why is the GOP ignoring this factor? Why the only solution to the problem is government interference in and assuming control of the health care insurance industry needs explanation?
The message is the same today from Democrats and Republicans, as it was a year ago, “get used to government control of the health care insurance and health care industries – it’s here to stay.”
While the federal government wishes to portray itself as the benevolent protector and the solver of all problems, the truth is the federal government has failed to be benevolent, has failed to be a protector as outlined in the Constitution, and causes more problems than it solves because of its continued violation of the Constitution. Governments are established among men to secure the individual God-given unalienable rights inherent to men, which include the right to life, liberty and the pursuit of happiness. The more government expands, the more it violates the Constitution and the people are expected to relinquish more unalienable rights. While some may disagree, no one has the right to use government to benefit from someone else’s labors nor does government have the authority to force individuals to hand over some of their labor to others. No matter which party or entity of government develops a plan for health care insurance, it inevitably involves individuals benefitting from someone else’s labors by government force.
All roads lead to a “single-payer, government controlled” health care industry, including insurance and system delivery of services, regardless of party affiliation. It’s about control of the people, nothing more and nothing less. Instead of direct democide, government can “cull the herd” through control of the health care system. After all, the western world is more “civilized” than to outright, directly murder citizens as was seen in the 20th century by communist governments, maniacal dictators, and lunatics.
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