Republicans are gearing up to replace President Barack Obama’s health care plan, designed to cover 30 million people who don’t have insurance.
The GOP’s main goal is cutting costs for people who already have health coverage — not creating a vast government bureaucracy to cover people who don’t. “Why do you have to upset the apple cart for everyone, when in fact there is a fairly narrow population that you’re trying to reach?” asked Rep. Michael Burgess (R-Texas), a physician.
The differences could be stark. The closest model to what Republicans are suggesting now — a substitute plan they offered in the House in November 2009 — would have covered just 3 million of the uninsured.Here's the audio version:
In fact, there is no House Republican plan yet …. The goals given to four committees drafting the plan suggest that Republicans will lean heavily on old GOP standbys, like cutting costs through medical malpractice reform, using small-business purchasing agreements to lower premium costs and putting patients with preexisting conditions into high-risk coverage pools … But the GOP has been short on details. “We’re not going to announce any numbers,” Rep. David Camp (R-Mich.), chairman of the House Ways and Means Committee, said. And there’s no sign of radically different ideas that will bring the Republican health care platform any closer to the scale of the new law. Republicans are betting the public is so turned off by what they see as a massive government overreach, they won’t care.
Critics say … the Republicans’ minimalist approach may not attack fundamental problems making the current health care system unaffordable and unsustainable.
Uwe Reinhardt, a health economist at Princeton University … “When you say, `We’ll do malpractice reform and cover three million people and do the high-risk pools,’ it’s almost a joke. That’s not really a replacement.” Added Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University … It has to get at the root causes of rising health care costs, which means changing the way the country delivers and pays for health care — another big topic that isn’t covered under the Republican ideas so far. “The real issue is, we can’t afford the health care system we’ve got,” Nichols said.
Here’s a rundown of what’s likely to be in the GOP plan, and how it compares with the current law.
High-risk pools … coverage for people with preexisting conditions. But rather than telling insurers they have to accept everyone regardless of their health — as the law does, starting in 2014 — Republicans would send federal money to the states to boost programs that already provide special, separate coverage for people with health problems.
Kenneth Thorpe, a health policy professor at Emory University … said the key is whether Republicans will budget enough money to keep premium costs in line. “The high-risk pools can be effective if you appropriately fund them,” he said. But most states haven’t put enough money into the pools, creating long waiting lists and higher premiums than standard insurance.
Selling health insurance across state lines: It’s a way to make health coverage cheaper, they hope, by letting people buy plans that don’t have to have all of the benefits and other rules that their own states require … in a 2005 study, the CBO estimated the idea would have cut premiums by only five percent, on average. The problem, Democrats say, is that it could become a “race to the bottom” if health insurers can skip too many rules about what should be covered and what protections consumers should have.
Small business purchasing pools … increasing competition is by letting small businesses join “association health plans … lower prices because, once again, the plans wouldn’t have to comply with all of the state rules.
In a 2008 analysis, the CBO said the idea would … make health insurance cheaper for other small business workers … But also found that it would make coverage more expensive for people who stayed in more regulated health plans, because most of the people who join association health plans would be healthy people with low medical costs.
Medicaid flexibility. give the states more leeway in what they have to cover under Medicaid and what they don’t. Republicans … like to cancel the expansion (in reform) rather than saddle the states with expensive new burdens, Burgess said.
Tort reform. The idea could save some money, according to the CBO. In a November 2010 estimate put the figure at $60 billion. That may sound like a lot, but it’s only about a half-percent of all health care spending in the United States.
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