Most Americans want the ObamaCare statute destroyed—completely repealed–polls say. But other options may be wiser for Americans’ health long term.
First, having health care as an issue “may actually be a blessing for the GOP,” says John D. Goodman, president of the National Center for Policy Analysis, and the author of 9 books and 50 studies on health policy. ObamaCare “was the single most important reason” for Republicans’ historic gains in the November election. The worst features of the law don’t kick in until 2014. As “an albatross hanging around Democrats’ necks, the law will be a big issue in the next election—a nightmare for the Democrat party.”
Second, “replace” could be better than exhaustive and probably fruitless efforts at immediate repeal. Obama would veto repeal. A market-based health care approach could reform the centerpiece of ObamaCare—namely, the health exchanges. It already is operating successfully in Utah. It’s a health insurance exchange for small businesses and individuals that could be a national model for competitive, minimal regulation health-care. It’s the sane answer to insane ObamaCare.
The health insurance exchange concept is the foundation stone of ObamaCare. That law, called the Affordable Care Act (ACA) by its misguided advocates, was to be fully implemented in four years. The exchanges are required in every state and have to meet certain federal standards by then. So says the present law.
The notion of state exchanges was to let individuals who don’t have Medicare and employees who don’t have insurance from their employers apply for tax credits and cost-reducing federal subsidies. If their income is under 138 percent of the federal poverty level, they could get Medicaid.
The exchanges are central to the operation of ObamaCare. Two states in addition to Utah have exchanges. In Massachusetts, it has proved to be an expensive near disaster. In California, the first state to establish an exchange, its success is uncertain, mainly because it is an entity of a state that’s essentially bankrupt.
Although the ObamaCare statute says states have a bit of leeway in designing their exchanges, the law—being federally built– has requirements that must be met. An Office of Consumer Information and Insurance Oversight (OCIIO), one of the 159 offices, agencies, and boards under the health law, lays out principles and priorities for exchanges, stating that it must have the capacity to do whatever is necessary to meet federal standards and stating that new regulations will be issued next year.
This OCIIO bureaucracy announced this month that the Department of Health and Human Services (HHS) will now require employers, health insurers, and others to disclose to policy holders that the health insurance they have doesn’t meet minimum standards required by law and by how much they fall short, according to Kaiser Health News. But some are given waivers, including some labor unions, such as a Service Employees International Union local and a Teamster Health Benefits Fund.
An indication of its arrogance: The act also stipulates that if, by 2013 the Secretary of HHS determines a state hasn’t made “sufficient progress” toward establishing an exchange the feds will come in, take over and “default the state into the one-size-fits-all federal program,” Health Reform Report wrote in October.
The blueprint for overhaul of Utah’s health-care system could well be the model for “a more rational approach to national reform,” according to a column by Kathleen Parker in the Washington Post.
Unlike the Congressional law drafters, Utah’s officials set forth practical solutions for real problems, rather than the all encompassing remake that put bureaucrats in charge. Looking through real-world lenses, Utah saw that most of the uninsured are in the lower income brackets and often work in small businesses.
Utah, therefore, sensibly created an exchange focused on improving insurance options for low-income workers and small businesses—1 to 50 employees, and then to be expanded to large employers. The exchange facilitates consumer choice based on price transparency, not government regulation-driven controls.
The Utah exchange is an internet portal. It connects consumers to information they need to make informed choices. They can make their choice electronically. Individuals are responsible for their health care and financing. They have a single shopping point where they can evaluate their needs from 15 options. Utah’s approach relies on personal responsibility, private markets, and competition, accurate and relevant information, real choice, and the opportunity to benefit from good choices.
The Utah exchange model was set up for $600.000, compared to Massachusetts at $25 million. It also offers relief to employers, who no longer need to bear the full burden of running a health plan for their employees.
Fifty-five percent of likely U.S. voters want ObamaCare repealed outright, according to a Dec. 20 Rasmussen Poll. And 52 percent said it was at least likely the health law would be torn out of the statute books.
Another approach to health care reform is sure to be the so-called Ryan-Rivlin plan. Rep. Paul Ryan (R-Wis.) will chair the House Budget Committee. Alice Rivlin, a Democrat, was the first chairperson of the Congressional Budget Office (CBO). She’s now at Brookings Institution.
Under the Ryan-Rivlin plan, the present Medicare system is dissolved and replaced by a new “Medicare” that would provide a payment—based on what the average annual per-capita expenditure is in 2021—to buy health insurance. A person would get the health insurance from a “Medicare Exchange.” Health plans which choose to take part in the Medicare Exchange must agree to offer insurance to all Medicare beneficiaries to ensure that the sickest and highest cost beneficiaries get coverage.
Medicare would, for the first time, become a rational system. Enrollees would pay out-of-pocket for small costs. But, starting in 2013, they would have a $6,000 cap on such expenses. By 2021, those eligible for Medicare would receive a voucher to buy private insurance instead of public payments. The voucher’s value would increase at the rate of growth of GDP plus 1 percent.
Medicaid would be transformed into block grants to the states each year. The value of the block grants also would grow as did the GDP rate plus 1 percent. The advantage of block grants is that they would allow the states to design the programs as they saw fit.
ObamaCare creators rarely pay homage to the Constitution. But they should be reminded of the Tenth Amendment, which says powers not granted to the federal government “are reserved to the states respectively, or to the people.”
And the people of Utah have a system that relies on personal responsibility, private markets, competition, and real choice, not federal control. What a stunning idea.