By Roger Stark / For The Herald
Health care has become a major policy issue in Congress. The recent government shutdown was caused by the minority party insisting on extending the deadline for the covid-era, generous taxpayer subsidies in the Affordable Health Care (Obamacare) exchanges. This was in spite of the fact that when in the majority, they were the ones who set the deadline to sunset the subsidies on Dec. 31, 2025.
Obamacare has been an abject failure. It has not provided universal health insurance coverage as was promised, nor has it controlled the ever-rising cost of health care. All Americans, except for people in the Medicaid entitlement, have seen their health care expenses go up. Congress was unable to repeal or replace Obamacare in 2017.
Congress is now at odds with itself on how to offer the country a new or revised plan for our health care system. Interestingly enough, a promising and comprehensive plan was presented in 2019.
The Congressional Republican Study Committee that year put together a proposal that retained the popular features of the ACA, retained Medicaid as a safety net program for the truly needy, and most importantly, gave patients much more control over their health care.
The plan eliminated the employer mandate and gave the employer tax credit to individuals through Health Savings Accounts. People could contribute to their HSAs using pre-tax dollars, could watch the invested funds in their HSAs grow tax-free, could use those dollars for an expanded list of health care expenditures, and could withdraw that money without paying taxes. From a practical standpoint, this would have eliminated the distortion caused by existing tax laws that favor employer-paid health benefits.
The maximum personal contributions to HSAs would increase to $9,000 per year for individuals and $18,000 for families. HSAs could be used for an expanded list of health care-related items, such as direct primary care, health status insurance, and paying for health insurance. The requirement for an accompanying high-deductible health insurance plan would have been eliminated.
Polls at that time showed that Americans liked the pre-existing condition and the guaranteed issue clauses in Obamacare. The 2019 plan addressed these items by prohibiting pre-existing condition exclusions and by the use of state-based guaranteed coverage pools. The plan also allowed states to provide alternatives, such as high-risk pools to cover patients with high costs and high utilization.
The plan also allowed the purchase of new insurance before COBRA funds were exhausted and encouraged the use of short-term, limited-duration health insurance plans for people in transition from job to job or from working to enrolling in Medicare.
Medicaid has not been sustainable in its current form for years. The 2019 plan placed a moratorium on further expansion of the entitlement and would have given states more control over the program through the use of per capita block grants. It would also have given states more flexibility by allowing greater use of the individual private market to cover Medicaid patients and by allowing states to combine their children in the Children’s Health Insurance Program with the Medicaid program.
Finally, the plan would have expanded the use of innovative care through greater use of:
• Direct primary care;
• Health care sharing ministries;
• Association health plans;
• Health status insurance (basically a form of re-insurance to cover unforeseen medical expenses);
• Short-term, limited-duration plans;
• Telemedicine; and
• The repeal of Certificate of Need laws.
The current health care debate revolves around some form of single-payer or Medicare for All program as opposed to incrementally expanding government control with a public option or a Medicare buy-in. On the other hand, the promising 2019 plan would have been a good start toward meaningful health care reform that puts patients, not the government, in charge of their own medical care.
Rather than nibbling around the edges of more socialized medicine, Congress should instead revisit the comprehensive health care reform proposed in the 2019 plan.
Dr. Roger Stark is a visiting fellow with Mountain States Policy Center, an independent research organization based in Idaho, Montana, Eastern Washington and Wyoming. Online at mountainstatespolicy.org. A retired surgeon, Stark has authored three books including “Healthcare Policy Simplified: Understanding a Complex Issue,” and “The Patient-Centered Solution: Our Health Care Crisis, How It Happened, and How We Can Fix It.”
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