Republican Health Plan????? The Shell Game Continues

Boehner, after months of foot dragging revealed his comprehensive plan to reform health insurance:

  • Number one: let families and businesses buy health insurance across state lines.
  • Number two: allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do.
  • Number three: give states the tools to create their own innovative reforms that lower health care costs.
  • Number four: end junk lawsuits that contribute to higher health care costs by increasing the number of tests and procedures that physicians sometimes order not because they think it’s good medicine, but because they are afraid of being sued.

Number 1: What does it mean to allow insurers to sell coverage “across state lines?”

Insurers could sell their products to Americans in any state. The insurer would have to follow the rules and regulations in the state where it is based or “domiciled” — not the rules of the state where the consumer or policyholder lives. Allowing the state laws chosen by the insurer rather than the laws of the state where the consumer lives to govern health insurance regulation is what makes this policy so controversial.

  • Premiums? Health insurance premiums may decrease for many young, healthy individuals. Yet, premiums would like go up for many other Americans, especially those people with health conditions or individuals who prefer comprehensive insurance policies.
  • Benefit Mandates? Most benefit mandates would be eliminated by an across state lines proposal. In fact, selling health insurance across state lines would eliminate any guarantee that important benefit mandates like maternity care would be included in insurance packages in the future. Consumers would get little in exchange — overwhelming evidence shows that benefit mandates per se are not why health insurance costs so much.
  • Access to Coverage? Many people would find it more difficult to access health insurance if health insurance were sold across state lines. This is because there would be fewer guaranteed issue policies and because insurers would have an increased incentive to deny people coverage and charge people more based on their health history.

Medicynical note: Any plan that doesn’t mandate use of community ratings rather than individual ratings is a waste of time and money. It’s tantamount to licensing insurers to charge those with illness more, which is no different from what we have now.


Number two: What does it mean to   “allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do.”

Medicynical Note: This is a revolutionary (sic) idea that………..is already available. The problem is that individuals with illness wanting to join such a group are not allowed entry, or charged so much that they can’t afford insurance–which is of course the problem with our current non-system. Insurers don’t want high risk sick people, in their pools. Guess who gets to pay for their care?

This is yet another great republican idea that doesn’t work out of the box. Now if they were to propose that such groups should accept all comers and that community ratings rather than individual ratings would apply the approach might be useful. As is, it’s another smoke screen.

Number three: What does it mean to: give states the tools to create their own innovative reforms that lower health care costs.”

Medicynical Note:  What does that mean?  It’s what my high school teacher called a glittering generality.  Details NONE!!

Number four: “end junk lawsuits that contribute to higher health care costs by increasing the number of tests and procedures that physicians sometimes order not because they think its good medicine, but because they are afraid of being sued.”

Medicynical note: What about valid lawsuits? This approach has not worked to decrease utilization or costs in states where it’s been tried. See Texas for example. I have no objection to fewer lawsuits simply to decrease the physician’s infinite personal liability. But there is no evidence doing this will decrease costs to a significant degree and make health insurance more efficient, available or affordable.
The emperor has no clothes, the republican health plan is not a plan.


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2 responses to “Republican Health Plan????? The Shell Game Continues

  1. President Obama is planning to reduce the cost of medical care by taxing it!
    So how many “not one dime” of taxes is that exactly?
    Codification of the “Economic Substance Doctrine” (Page 349): Empowers the IRS to disallow a perfectly legal tax deduction or other tax relief merely because the IRS deems that the motive of the taxpayer was not primarily business-related.
    Oh, yes, your kind compassionate and sensitive IRS Agent…
    Individual Mandate Surtax (Page 296): If an individual fails to obtain qualifying coverage, he must pay an income surtax equal to the lesser of **2.5 percent** of modified adjusted gross income (MAGI) or the average premium. MAGI adds back in the foreign earned income exclusion and municipal bond interest.
    “If you want a vision of the future, imagine a boot stamping on a human face – forever.”– George Orwell

    • Currently we pay for health care with inflated fees dictated by the jack booted insurance and medical industrial complex. We pay twice as much for our care as other industrialized countries without any improvement in longevity. The most expensive purchase during your life will not be your home, but rather your health care. Single drugs cost over %100,000/year–we pay significantly more than any other country in the world. 60% of bankruptcy in our country comes at least in part from this “boot stamping” system. In other countries zero % of bankruptcy is from health care costs.

      We have a non-system of care. Change, including paying part of it with taxes, must come. Overlall I’d bet that collectively we’ll be paying less for health care in ten years with reform.

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