Yeah, and That, Too

We are in a series looking at the recently published Republican plan for the ‘repeal and replace’ of the Affordable Care Act. Click here to find other posts in the series.

Look at me.  Concentrate.  Don’t get distracted.  Focus.

Yes, yes, there have been some ‘leaks’ in D.C. related to the draft of the Republican’s actual healthcare bill.  Some (OK, me) have suggested the President himself might have been the leaker, glad to have a leak that did not include the word ‘Russian’ anywhere in the story.

I promise, we’ll take a look at leaked legislation later this week, but for the love of all that is good and right, let’s finish the summary of the published policy brief today.  We only have two little pieces left. 

The first is to revise the rules and expand Health Savings Accounts (HSAs).  Well, of course.  This is a ‘copy and paste’ staple of every conservative healthcare funding proposal floated over the past 30 years.  Sure, there is some minor lost tax revenue when people are allowed to pay for things with pre-tax dollars, but this is part of the pledge you say when you join the Young College Republicans.  ‘Market solutions…individual responsibility…Ronald Reagan…go team.’

The second is to provide ‘state innovation grants for high risk pools,’ and like the HSA plank, this one has deep conservative bona fides.  There is a recognition that  pure market solutions don’t work in healthcare because a small percentage of the folks are really sick and could never afford coverage based on their actual expected healthcare costs.  So some form of tax redistribution ‘compassion’ (sorry, I got off script there for a second) from the majority to these high risk/high cost group is required.  But, the idea is to pass on the money and let the states handle this. ‘Tenth Amendment…50 laboratories of innovation…remember that Lincoln was a Republican…go team.’

OK, to recap, the Republican policy framework:

  • Drops the individual mandate and the exchange subsidies, replacing that with refundable tax credits to help people who are not covered by their employer or the government buy insurance on the open market.
  • Reforms Medicaid by eventually phasing out the extra federal subsidy to the states for the ACA expansion and, simultaneously, moves Uncle Sam to more of a funding source while giving the states lots of freedom on how they figure out their own Medicaid program.
  • Expand HSAs so people can better handle the increasing portion of the healthcare bill they will have to pay directly.
  • Provides some additional money to the states to help fund ‘high risk pools’ that cover expensive people who can’t get coverage in the normal market.

Yes, this is a gross oversimplification, but is should be able to get you through a discussion at the scrub sink.

No, we are not done.  This was just the policy brief.  But it sets the stage so we can now pick up the play by play of the actual sausage-making process that turns the talking points document into Congressional action.

Ain’t this a hoot?


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Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

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