Sun Sentinel Palm Beach Edition
Changing health care
Proposals to repeal, replace health law hit hard realities
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, as well as new Health and Human Services Secretary Tom Price, favor bringing back slimmed down health plans that were 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 law are 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 health care. “It’s an unbelievably complex subject. Nobody knew that health care 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 a major 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 lowers 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 HealthPocket, 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 as much 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.