Chang­ing health care

Pro­pos­als to re­peal, re­place health law hit hard re­al­i­ties

Sun Sentinel Broward Edition - - FRONT PAGE - By Noam N. Levey

The Repub­li­can Party’s emerg­ing pro­pos­als to over­haul the health care sys­tem would shift more costs onto pa­tients.

WASH­ING­TON — Repub­li­cans came into of­fice this year promis­ing to res­cue Amer­i­cans from ris­ing health care bills by re­peal­ing and re­plac­ing the Af­ford­able Care Act.

But the party’s emerg­ing health care pro­pos­als would shift even more costs onto pa­tients, feeding the very prob­lem GOP politi­cians com­plained about un­der Pres­i­dent Barack Obama’s sig­na­ture health law.

And their so­lu­tions could hit not only peo­ple who have ACA health plans, but tens of mil­lions more who rely on em­ployer cov­er­age or on gov­ern­ment plans such as Med­i­caid and Medi­care.

House Speaker Paul Ryan, R-Wis., and other con­gres­sional lead­ers, aswell as new Health and Hu­man Ser­vices Sec­re­tary Tom Price, fa­vor bring­ing back slimmed down health plans thatwere phased out un­der the law also known as Oba­macare. Such “catas­trophic” plans typ­i­cally of­fer fewer ben­e­fits and often re­quire pa­tients to pay much larger de­ductibles.

Many in the GOP also want poor peo­ple who rely on Med­i­caid to face more co-pay­ments and higher pre­mi­ums, cit­ing the need for such pa­tients to have “skin in the game.”

On Mon­day, Pres­i­dent Don­ald Trump warned that the U.S. health care sys­tem was in dan­ger of im­plod­ing and that fun­da­men­tal changes to the sweep­ing health laware needed.

Trump said dur­ing a White House meet­ing with gov­er­nors that he hoped to over­haul the Amer­i­can tax sys­tem but that was a “tiny lit­tle ant” com­pared to health­care .“It’ s an un­be­liev­ably com­plex sub­ject. No­body knew that health­care could be so com­pli­cated,” Trump said.

De­vel­op­ing House Repub­li­can plans to re­place the ACA would scale back gov­ern­ment in­surance sub­si­dies for mil­lions of low- and mod­er­ate-in­come Amer­i­cans who rely on the aid to buy cov­er­age.

To fund a health care over­haul, Repub­li­cans are ex­plor­ing ways to scale back tax breaks on health in­surance, a move that could mean a tax hike for peo­ple who get cov­er­age through an em­ployer.

Mean­while, other GOP plans to re­form Medi­care — which Ryan and Price have cham­pi­oned — would pro­vide se­niors with vouch­ers to shop for com­mer­cial health plans, an ap­proach that in­de­pen­dent analy­ses sug­gest could leave many pa­tients pay­ing more.

Those are po­lit­i­cally risky ideas, said Robert Blen­don, an author­ity on pub­lic at­ti­tudes about health care at Har­vard Univer­sity. “Skin in the game has been never pop­u­lar,” he said. “It may be an econ­o­mist’s dream. But it’s never been some­thing peo­ple say they want.”

The GOP pro­pos­als also could prove ama­jor ob­sta­cle as Repub­li­cans la­bor to con­vince skep­ti­cal Amer­i­cans that they have a bet­ter al­ter­na­tive to the ACA.

Repub­li­can lead­ers ar­gue their ideas will trans­form health care mar­kets across the coun­try as gov­ern­ment reg­u­la­tions are pared back, driv­ing down costs.

“We be­lieve in a pa­tient­cen­tered sys­tem, where in­di­vid­u­als have the free­dom to buy what they want and not what the gov­ern­ment makes them buy,” Ryan told re­porters at the Capi­tol re­cently. “It’s re­ally, re­ally im­por­tant to have choice and com­pe­ti­tion in health care be­cause choice and com­pe­ti­tion lowe rs cost and in­creases qual­ity .”

GOP law­mak­ers have tapped into fer­tile ground with their re­lent­less at­tacks on ris­ing costs. Though in­surance pre­mi­ums are gen­er­ally in­creas­ing more slowly than they have in the past, many con­sumers are still seeing steep in­creases.

The in­creases have been dra­matic on the in­surance mar­ket­places cre­ated by the health care law, which serve only about 11 mil­lion peo­ple but have be­come the law’s most vis­i­ble pro­gram.

This year, the av­er­age an­nual de­ductible for a sil­ver plan for a sin­gle adult on the mar­ket­places hit $3,572, ac­cord­ing to a sur­vey by Health Pocket, an on­line in­surance shop­ping tool.

Most ex­perts be­lieve high health care costs are be­ing driven pri­mar­ily by the high price of med­i­cal ser­vices in the U.S.

The av­er­age cost of a hip re­place­ment, for ex­am­ple, is nearly twice that in Switzer­land or Great Bri­tain. Many brand-name phar­ma­ceu­ti­cals cost two or three times what they do in other in­dus­tri­al­ized coun­tries.

But most GOP pro­pos­als fo­cus on pa­tients pay­ing more for care as a way to con­trol ris­ing pre­mi­ums.

A fa­vorite Repub­li­can strat­egy is to in­crease use of high-de­ductible health plans, cou­pled with tax-free health sav­ings ac­counts, or HSAs, which con­sumers can use to set aside money for med­i­cal ex­penses.

Un­der cur­rent law, high­d­e­ductible plans can re­quire sin­gle peo­ple to pay as­much as $6,550 be­fore in­surance kicks in. Fam­i­lies can face de­ductibles as high as $13,100. Con­sumers who have qual­i­fy­ing high-de­ductible plans can put aside as much as $3,400 an­nu­ally in a health sav­ings ac­count (or $6,750 if they have a fam­ily health plan). Many Repub­li­cans fa­vor al­low­ing Amer­i­cans to put away even more in th­ese ac­counts.

PABLO MARTINEZ MONSIVAIS/AP

Emerg­ing health care ideas by Speaker Paul Ryan and the GOP could bring higher costs.

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