Republicans Take Steps to Fix Health Care in New Congress

Candidates can win on health care.
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In anticipation of a more favorable political landscape in Congress next year, Rep. Pete Sessions (R-Tex.) has introduced legislation that would undo key provisions of Obamacare and promote choice in how Americans receive their health care.

Sessions’ bill, the “Health Care Equality and Modernization Act of 2022,” (H.R. 7258) is largely an updated version of a measure Sessions and Sen. Bill Cassidy (R-La.) introduced in 2016.  The new bill would “eliminate the individual and employer mandates under the Patients Protection and Affordable Care Act [ACA, or Obamacare], to expand beyond that Act the choices in obtaining and financing affordable health insurance coverage, and for other purposes.”  Additionally, several reporting requirements tied to individual and employer mandates would be eliminated.

The Sessions bill also would clarify an employer’s ability to reimburse employee premiums for the purchase of individual health insurance coverage under a health reimbursement arrangement.

Under the bill, certain consumer protections contained in the ACA, such as bans on denying coverage to people with preexisting conditions, prohibitions on discrimination based on health status, and coverage of dependents through age 26, would remain in place.

State Control Over Insurance

Another goal of the bill is to create state flexibility by ensuring a competitive health insurance market outside the Obamacare exchanges.

“With respect to health insurance coverage offered in a State, the State may, in consultation with the Secretary [of HHS], take such steps, such as limiting the availability of general open enrollment periods, imposing delays in the effectiveness of coverage, permitting differentials in premiums based on age and other factors, as the State determines necessary in order to ensure an orderly market for health insurance coverage in the State that is not offered through an Exchange,” states the bill.

The bill also allows a state to “provide for the enrollment of residents of the State who are uninsured in default health insurance coverage … and establishing a Roth HSA (Health Savings Account) for such residents who do not have a Roth HSA unless the resident has affirmatively elected not to be so enrolled and not to have such an account, respectively.  If a State makes such an election, the state shall permit eligible residents to enroll in such coverage on a continuous basis.”

The bill also has provisions that would allow states to “permit the adjustment of risk among health insurance coverage” in the individual market, similar to the risk adjustment used in Medicare Advantage plans.

Getting Back to Insurance Basics

In keeping with the bill’s goal of enhancing consumer choice, Sessions’ legislation encourages states to offer “basic health insurance” on exchanges serving state residents.  It defines basic health insurance as “such health insurance coverage as a State may specify and includes limited benefit insurance…”

Defenders of the ACA sometimes refer to basic health insurance as “junk plans,” showing their clear preference for government-directed insurance coverage.

Tax Credits for Health Care

One of the bill’s most innovative features is the proposal to take all health care-related tax and spending subsidies and direct the money to create a refundable tax credit for everyone not on a government program, such as Medicaid or Medicare.  It also makes employer-provided health insurance portable and allows employees to have 24/7 access to “direct primary care” without having to go to the emergency room at night or on weekends.

With Democrats in control of Congress and the White House, Sessions’ bill has no chance of passage this year.  It could, however, pick up steam next year if Congress changes hands in the November midterms.  Even then, it would face a certain presidential veto.  But in that case, the bill would become part of the larger health care debate leading up to the 2024 presidential election.

“The Sessions health plan is an idea whose time has come,” said John Goodman, president of the Goodman Institute and co-publisher of Health Care News.. “The core concept: Take all the spending and tax subsidies we now provide to private health insurance and use that money to give every American not on a government plan a refundable tax credit.”

“This would empower people instead of employers and insurance companies,” he added.  “Competition in the marketplace would be the vehicle to meet consumer needs.”

Dean Clancy, a senior fellow in health care policy with Americans for Prosperity, agrees.

“The Health Care Equality and Modernization Act would give Americans a personal option instead of a one-size-fits-all government option, empowering them with more choice and control and removing barriers between patients and medical professionals they trust,” Clancy told Health Care News.  “This is what real health reform looks like.”


Bonner Russell Cohen, Ph.D. (bcohen@nationalcenter



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