Many people, including several on this very site, have claimed that the Republicans don’t have a proposal for replacement of the PPACA. Those people are wrong. On the House Republican website, an official healthcare reform bill was posted during the 111th Congress.
So, rather than continuing to shadow box, let’s take a look at their official proposal, shall we?
Here’s a high-level rundown of what’s in the bill:
- Require high-risk pools (or some equivalent) be available in all states, with a maximum premium of 150% the average general-risk insured. The high-risk pools must be adequately funded by the states, with $1.5B per year subsidy from the federal government. Non-citizens are prohibited from participation in the high-risk pools if those pools have any funding from the $1.5B/year bucket.
- Elimination of annual and lifetime spending caps.
- Make rescission more difficult for insurers, by disallowing inadvertent disclosure as a justification for rescission. Disputes are to be reviewed by a third party, with rules established by the Secretary of Health and Human Services.
- Bonuses are to be paid from the federal government to states that show significant reductions in average premiums, or reductions in the percentages of uninsured.
- States would be required to provide insurance plan finding services, though they may choose to contract with a private company to provide the service. The service may cover multiple states. The insurers would be required to standardize the descriptions of their offerings to enable comparison shopping. The service provider cannot also offer insurance.
- Requires that children who are eligible for coverage continue to be eligible up to their 25th birthdays.
- Allows for purchase of health insurance across state lines. In such cases, the laws in effect are those of the insurer’s state, not the insured’s. The insurer is required to clearly inform the insured of the state under whose jurisdiction the insurer falls. The insurer is also required to offer insurance in the insurer’s state.
- Prohibits insurers from reclassifying the insured as higher risk, regardless of the changing health of the insured, provided the insured has maintained a current policy with the insurer. The premiums can still rise, either for everyone in the same class, or due to increased age of the insured.
- Some minor expansions of HSAs.
- Tort reform. There’s nothing new here; it’s the same thing Republicans have been pushing in nearly every industry for decades. Punitive damages would be allowed only if there was intent to harm, not if there was gross negligence. Statutes of limitations are tightened, and maximum awards are reduced, with no provision for inflation adjustment.
- The $1.1B comparative effectiveness program in the ARRA is discontinued.
- No federal funds can be used to cover abortions. This would effectively preclude any member of a high-risk pool from having abortion coverage.
- Finally, there’s some stuff in there to ease approval for new drugs, by reducing the required amount of clinical evidence of efficacy and safety.
It’s a big list, though not as substantial as the number of bullet points would suggest. Several of them are either identical or very close to elements of the PPACA. The major differences are adding tort reform and interstate insurance, and removing the minimum standards, pre-existing condition coverage, insurance mandate, and low-income subsidy.
In a few days, I’ll discuss my expectations on the impact of a hypothetical replacement of PPACA with the Republican proposal, as well as thoughts on what a more ideal hybrid might look like.
In the meantime, the floor is yours. Talk about the real proposal, instead of insisting there isn’t one.
- The GOP’s 5 Most Absurd Lies About Healthcare Reform, Debunked (alternet.org)
- Obama healthcare reform wins centrists even as repeal looms (medcitynews.com)
- After Repeal Vote, Healthcare Reform Fight Goes On (usnews.com)
- “Support For Repeal Of Healthcare Reform Hits All Time Low” and related posts (intoxination.net)
- The business case against repealing healthcare reform (salon.com)