GOP: No Health Plan in Sight

Republicans aren’t even convinced they will find consensus on any specific set of new health care bills. The ideas they’re discussing — the ability to buy insurance across state lines, wider use of health savings accounts and cutting federal regulations — are the same principles they have kicked around since 2009. But the party is not much closer to finding a proposal — or set of proposals — that would garner enough Republican support to pass the House. (Politico)

I thought the folks at Politico were supposed to be on top of things. I explained why the GOP can’t get its act together a year ago.

Comments (16)

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  1. G. King says:

    Woo…partisan struggle..

  2. G. King says:

    Politico ignores the ideas that both parties should embrace.

  3. Matthew says:

    Each party is struggling to come up with decent solutions. The GOP will lead to nowhere and the Dems lead us into the ground.

  4. Jay says:

    The GOP desperately want to replace ObamaCare, but if they can’t come up with a policy they all agree on, then what’s makes theme more credible than Obama’s policy?

    • Thomas says:

      “the party is not much closer to finding a proposal — or set of proposals — that would garner enough Republican support to pass the House”

      It doesn’t make them credible at all. They can’t repeal and replace ObamaCare if the Republicans can’t come up with a solution they all agree on.

      • Andrew says:

        Not only a solution they agree on, but a solution the people agree on as well. We don’t need the Republican version of ObamaCare and more dysfunction for health care access.

      • Perry says:

        It’s very disappointing. I think Obamacare is a disaster, but we definitely need a good plan to lead us out of it.

    • James M. says:

      “Richard Burr of North Carolina, Orrin Hatch of Utah and Tom Coburn of Oklahoma — have offered a proposal to repeal and replace Obamacare with “market-based reforms,” mainly in how employer-based health coverage is taxed.”

      This is the bill that seems to be a viable solution. Market-based reforms is where need to head to.

  5. Bart I. says:

    “Newt Gingrich had a comprehensive health plan in last year’s Republican primary. It was my plan. Four years ago John McCain had a comprehensive health reform. That was also basically my plan. Mitt Romney oversaw health reform in Massachusetts. That was a Heritage Foundation plan.”

    Unfortunately the former candidates all have one thing in common…

    The plan may be fine as a long term goal, but as a campaign platform it’s a millstone around any candidate’s neck. What’s lacking is a migration path, with a first step that is both substantial (as a first step) and can appeal to a wide number of supporters. This first step is what should be used as the campaign platform.

  6. Bob Hertz says:

    Bob Lascweski has a very good post about just how lame the old war horse of buying insurance across state lines really is.

    You would have reinstate full underwriting for this to make any difference at all.

    With full underwriting, a healthy young man in New York could buy a cheap underwritten policy from Arizona.

    This not such an awful thing, but it does absolutely nothing to solve health insurance for the unhealthy people left behind in New York.

    In theory, the unhealthy persons in New York could be covered by a high risk pool. And a fully funded high risk pool for the nation would cost a lot of money.
    I would guess at least $50 billion a year.

    But one of the Republican proposals last year included $25 billion over 10 years for high risk pools. That is laughable.

    • Barry Carol says:

      Bob,

      The estimate I’ve seen most often of the number of Americans who would be uninsurable by traditional medical underwriting standards is 4-5 million excluding the 65 and over population who qualify for Medicare as well as those who have been on Social Security disability for at least two years who also qualify for Medicare. I estimate it would cost taxpayers between $80-$100 billion per year to insure this group less whatever could be collected from the insureds in income based health insurance premiums which might be a quarter of that amount or less but I don’t know for sure.

      The problem is that this number is likely to grow. If you take someone who had successful heart surgery and is then managed by medication for a number of years, he will always be considered uninsurable using traditional underwriting. In the meantime, more people will become uninsurable and would either not be renewed or would be subject to a huge increase in premiums thus becoming, in effect, uninsurable going forward.

      The bottom line is that the Republicans, who I generally support on most economic issues, are out to lunch when it comes to healthcare and health insurance. If you want to use medical underwriting, you need to be prepared to spend a huge amount of money on high risk pools to take care of the relatively small percentage of the population that can’t pass underwriting. If you want to require insurers to insure all comers at reasonable rates regardless of pre-existing conditions, you need a mandate, either individual or employer.

      With guaranteed issue but without a mandate, you will get adverse selection on steroids. Just ask the folks in New York how that worked out. NY added insult to injury by requiring pure community rating as well which meant healthy people in their twenties had to pay over $600 per month for individual coverage. Ouch!

      • Bart I. says:

        Barry, I agree with part of your third paragraph, but not all. I agree that risk pools would be expensive in an all-underwritten scheme, and the idea of paying for both the risk pools and a large universal tax credit never made sense to me.

        But employer-sponsored coverage is community rated and doesn’t require an explicit mandate, although requiring participation in an employer plan to qualify for the tax exclusion is a sort of mandate. A better-designed tax credit for ESI, COBRA, and similar plans would probably cover more for the same or lower cost.

        • Barry Carol says:

          Bart,

          The important aspect of most large employer health insurance plans that I’m familiar with but many may not know about is that if you don’t sign up when you’re initially hired you can’t get the insurance later unless you can pass medical underwriting. The exception is if you were covered under a spouse’s plan but then lost that coverage because of divorce, the spouse died or lost his or her job. Most large employers with a typical employee age distribution spend between $5,000 and $6,000 per covered life for health insurance claims plus modest administrative costs. That includes employees’ children who are relatively cheap to cover though low birth weight preemies can be hugely expensive, especially in the case of multiple births with severe complications. If employees were allowed to decline the insurance at first to avoid paying their share of the premium and then ask for it later if they got sick, employers would have the same adverse selection issue that affects the individual market in the absence of a mandate.

          Regarding COBRA, only about 2% of eligible employees take it up because they generally can’t afford to pay the premium themselves especially if they were just laid off. Some pay for it because they only need it for a brief period before starting another job or aging into Medicare. Others have significant current healthcare costs and either pay the premium with savings or with help from family members or even credit cards. Even if they could pay with pretax dollars, it probably wouldn’t make much difference especially if their income dropped off a cliff due to unemployment.

          • Bart I. says:

            Barry,

            It’s true that employer plans’ version of community rating differs from that mandated in NY.

            As you say, plan changes can only occur in response to qualifying events or during the annual window. This is actually less restrictive than Medicare Part B, where for every year you delay signing up your premium increases by 10% for life.

            Small-employer plans in some states are age-banded; in fact it’s been argued that all employer plans are effectively age-banded, since employers and employers both know a hires’ approximate age or years of experience, and can’t help but take that into account when settling on a salary.

            And of course you have to be employable to have access to an employer plan, which would tend to reduce costs. But this may be balanced by the fact that some people with high health costs seek employment primarily for the coverage.

            COBRA was just an example of a type of community-rated coverage that could be subsidized by a tax credit without killing employer plans due to adverse selection. I imagine the COBRA take-up rate has been historically low in part because many of those eligible were able to qualify for cheaper underwritten plans; the only reason for using COBRA would be because you were older or had a medical history. In that case COBRA is generally cheaper than any other community-rated coverage (not counting subsidies).

            Whether some people need additional help beyond a 25% or so tax credit is a legitimate question but a separate one.

  7. Bob Hertz says:

    A rather hidden (but powerful) theme of American health insurance since the 1950′s
    has been the attempt by healthy persons and healthy groups to escape into their own risk pool.

    Insurance companies only entered the health care field when they could cherry pick the healthy groups away from the old Blue Cross plans.

    Companies like Golden Rule only entered the individual market when they could cherry pick the healthiest segment of the population.

    In this tug of war, the government has usually been trying to drag the healthy persons back into a more universal pool. Naturally the healthy persons resist, as this means real dollars out of their pocket.

    The Republicans are on the side of the resistors. It is possible that the government has the upper hand this time, but you never know.