After two years of upheaval caused by the coronavirus and growing political division, this year’s mid-term election could be the biggest test yet on which party has the most appealing plan to fix the country’s health care woes.
Politics has been an obstacle to health care reform, says Rep. Chip Roy (R-TX).
“Politicians and bureaucrats have diminished Americans’ health care freedom and for stupid reasons—enriching insurance companies and empowering bureaucrats to control the health care industry—all for political gain,” said Roy.
Democrats, who control Congress and the White House, tried to push through an ambitious plan, including price restraints on prescription drugs and beefing up Obamacare, in the $2 trillion social spending bill. The party’s thin margin in the Senate, however, failed to get the package over the finish line.
In 2017, Republicans were in control and failed to come up with an Obamacare replacement. Republicans are gearing up for a possible takeover of Congress. To avoid a repeat of 2017, House Republican Leader Kevin McCarthy has set up a “Healthy Future” task force.
Health Care Choices Plan
A centerpiece of the McCarthy task force is the Health Care Choices plan, the culmination of two years of work on reform measures by 81 think tanks and grassroots organizations, under the direction of the Galen Institute.
The plan was a “huge accomplishment,” but needs better marketing than in 2020, says John C. Goodman, president of the Goodman Institute and co-publisher of Health Care News, in his email newsletter on February 19.
“We should begin by saying Obamacare has made health insurance unaffordable and the best doctors and hospitals inaccessible,” wrote Goodman. “In other words, we should go right to the heart of what the other side promised and didn’t deliver; and then pledge to do what they didn’t do by empowering individuals and letting markets work.”
Big Leap or Baby Steps?
Baby steps, not an all-out revamp, is the prudent approach, says Grace-Marie Turner, president of the Galen Institute.
“Opinion polling consistently shows people do not have an appetite for another massive revamp of our health care system,” said Turner. “They want it fixed in a way that won’t be as disruptive as Obamacare was.”
The Health Care Choices plan has 35 specific recommendations organized around key concepts like personalized health care, lower costs, better coverage, and safety nets, says Turner.
“It’s organized around a central theme but also offers a menu of policy proposals,” said Turner. “If someone is concerned about hospital consolidation, we have some ideas for you. Or, if you’re more focused on affordability or the vulnerable not having access to quality health care, we have recommendations there.”
Reaching Across the Aisle
Given the struggles both parties have had fixing health care when they had full control in Washington, this could be the year for an earnest effort to reach across the aisle.
In fact, there was a sign of that during a hearing before the House Education and Labor subcommittee titled, “Exploring Pathways to Affordable, Universal Health Coverage,” on February 17. Reps. Pramila Jayapal (D-WA) and Mark DeSaulnier (D-CA) expressed an interest to learn more about pro-market reforms Galen Institute senior fellow Brian Blase mentioned in his testimony.
Jayapal asked questions on hospital consolidation and DeSaulnier wanted to explore ways to help small businesses find affordable plans for employees.
Turner says she was encouraged by that because there is a common ground where both parties can win.
“Every congressional district has a small business coalition they need to please, and a reform proposal like association health plans could help a great deal in lowering premiums and offering more choices,” said Turner.
Selling Reforms to Voters
One of the biggest challenges will be selling reforms to voters on something as complicated as health care.
Goodman and Marie Fishpaw of the Heritage Foundation pulled 10 key benefits out of the Health Care Choices plan a candidate could easily sell voters, including letting insurers compete by increasing subsidies in Obamacare plans based on patients’ health risks; giving families a tax credit to set money aside money for a “safety net” so they feel more at ease choosing a lower-cost plan with a higher deductible; and letting employees “own” their employer insurance with health reimbursement accounts.
Candidates could pitch creating Medicare Roth-style health savings accounts to reward enrollees for lower utilization (see article); allowing direct primary care to be used in all health care arrangements; requiring more price transparency, and eliminating competition killers like certificate-of-need approval and scope-of-practice restrictions.
‘Americans Should Have Personalized Care’
One challenge candidates face is explaining to voters why “free” Medicaid or government-subsidized health insurance comes at the price of encouraging small businesses to drop or not offer health care, says Turner.
“The employer health system in this country has been the bedrock,” said Turner. “But we are at risk that it erodes to the point that a government plan or program will be the only choice for millions of people.”
Roy says it is important for Republicans to get on the same page.
“Republicans’ message to the American people should be simple: Americans should have personalized care, should be able to choose the doctor or plan of their choice, and we should get the insurance bureaucrats, government bureaucrats, and ‘big health care’ out of the way,” said Roy.
“We should fight for policies that will bring down costs through competition and innovation, not through the crony capitalism that has only fueled our healthcare system’s problems,” said Roy. “This is a message everyone ought to be able to get behind.”
AnneMarie Schieber (firstname.lastname@example.org) is the managing editor of Health Care News.