Health care reform that works

Republican candidates across the country are getting pummeled with ads by challengers using an upcoming Supreme Court case as the weapon to frighten millions of Americans into believing they will lose their health care and pre-existing condition protections if the Affordable Care Act (ObamaCare) is struck down. The issue was front and center in this week’s Senate Judiciary Committee hearings on the confirmation of Judge Amy Coney Barrett to the high court.

There is little or no chance the court will so significantly reverse course and declare the entire Affordable Care Act unconstitutional because the individual mandate no longer contains a tax penalty. But candidates need to show that they have a plan to protect the vulnerable.

And there is an impressive consensus around how to do that. Every Republican in Congress has pledged to protect pre-existing conditions, and the conservative approach would dedicate resources to provide extra help for those with greater health needs, unlike ObamaCare, which threw them into the same insurance pool with everyone else.  The result:  Premiums and deductibles soared and healthy people dropped out because insurance often costs more than their mortgage payment. Taxpayers are now getting soaked for $1.8 trillion over the next decade in payments to health insurance companies to subsidize coverage for a dwindling number of people.

We can do better. The centerpiece of the Health Care Choices proposal would devolve power and control away from Washington by replacing ObamaCare’s entitlements with grants to states. Our proposal would devote a portion of the grant to fully support people with pre-existing conditions, without all the collateral damage inflicted by ObamaCare.

The grants would give states more flexibility – with guidelines – and free up resources to allow them to decide how best to make health insurance affordable and available regardless of income or medical condition. 

Experiences in a number of states receiving State Relief and Empowerment Waivers shows they can create better ways to help those with pre-existing conditions and high medical costs.

By redirecting existing resources, coupled with regulatory flexibility, states have shown they can create a safety net for the vulnerable and better meet the needs of healthy citizens with more choices of plans and innovative options for more affordable care. State high-risk pools, “invisible” high risk pools, reinsurance or other risk adjustment arrangements target resources to finance care for higher-risk patients. Wisconsin lowered premiums by 11 percent; Minnesota by 20 percent; and Maryland by 43 percent, for example. That also brought more healthy people back into the market, all without additional federal spending.

Conservatives are converging around a mosaic of many other targeted solutions suited to the complexities of our $3.8 trillion health sector, yet they are criticized from all sides for not having “a plan.” But the conceit that conservatives should offer another trillion-dollar top-down, government-run Washington-knows-best “plan” to re-engineer the health care system is one only “Medicare-for-All” advocates are audacious enough to advocate.

The Health Care Choices plan would get government out of the way and redirect resources and incentives to free patients to purchase the coverage that meets their needs (with assistance for those with lower incomes and higher health costs), free states to approve a broader range of plans and empower innovators to respond with new products and services that improve health outcomes and lower costs. We have seen how quickly the private sector can respond during the COVID crisis, when companies mobilized to produce supplies, treatments and, soon, a vaccine at warp speed.

There are consistent themes in the array of conservative health reform proposals — from the Health Care Choices proposal developed by the Health Policy Consensus Group, to the House Republican Study Committee’s Agenda for Better American Health Care, to President Trump’s executive order America-First Healthcare Plan. 

If the Supreme Court were to decide, in the pending ObamaCare challenge, that some or all of the law’s provisions must go, Congress could quickly enact different and better solutions to unleash the innovation and energy that have been pent up in our health sector. The proposals address surprise medical bills, prescription drug costs and price transparency, and would break up market concentration, reform public health agencies, reduce red tape and support care delivery options such as telehealth, direct primary care, health sharing ministries, health savings accounts and countless other innovations in health care.

Congress also could codify the Trump administration’s regulatory changes to allow people access to more affordable short-term health insurance policies, association health plans that allow small businesses to join together for more affordable polices and health reimbursement arrangements, which are like 401(k)’s for health coverage. 

And that’s just the start of what’s possible when applying a sensible, targeted approach to reform.      

Grace-Marie Turner is president of the Galen Institute, a non-profit research organization, where she facilitates conversations among market-based health policy experts participating in the Health Policy Consensus Group.