Beginning of a GOP alternative to Obamacare?

[travelover]

+1 A critical first step for healthcare reform would be to divorce health insurance and employment. IMO, the resulting larger pool of insureds would make individual health insurance more affordable, there would be more competition.... I think it would be a very good thing albeit difficult politically. Employers could subsidize health insurance by contributing to a HSA on an employee's behalf.

I also think there needs to be more mandated transparency about the cost of procedures so consumers can price and comparison shop if they want to.... if they decide not to then fine, but they should be provided the information to make that choice.

Totally agree, and the two ideas are tied together. With the insured oblivious to both the premiums and the charges for services it was easy for costs to balloon.

 

[Mulligan]

+1 A critical first step for healthcare reform would be to divorce health insurance and employment. IMO, the resulting larger pool of insureds would make individual health insurance more affordable, there would be more competition.... I think it would be a very good thing albeit difficult politically. Employers could subsidize health insurance by contributing to a HSA on an employee's behalf.

I also think there needs to be more mandated transparency about the cost of procedures so consumers can price and comparison shop if they want to.... if they decide not to then fine, but they should be provided the information to make that choice.

No disagreement with you at all, but if this ever happened you know the workers currently receiving this benefit would get the royal shaft without a preparatory greasing. They probably would get half of it added to their salary and the other half would mysteriously disappear into the monthly company cashflow statement!


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[eytonxav]

While it seems like a no brainer, I think that Katsmeow brings up a critical point, below. There really has to be some Federal level guidelines to ensure it is not a race to the bottom.

I am not sure I follow this concern. Its all about creating unfettered competition across all state lines, and no states should be able to regulate more or less than any other.

 

[pb4uski]

No disagreement with you at all, but if this ever happened you know the workers currently receiving this benefit would get the royal shaft without a preparatory greasing. They probably would get half of it added to their salary and the other half would mysteriously disappear into the [-]monthly company cashflow statement[/-]our quarterly dividends!

FIFY. Just kidding. No, you are right, that is a potential issue but if you implemented it during a time of high demand/low supply of human capital then employers would have an incentive to try to be fair. I wouldn't even mind mandating that employer's provide an explanation of their expected health care subsidy costs before and after enactment.... mind you, not mandating that they have to make employees whole but rather that they have to disclose what they did so employees and investors can see whether employees were made whole or not. It would be sort of fun to watch. I actually think that many employers would play fair.

 

[NW-Bound]

I also think there needs to be more mandated transparency about the cost of procedures so consumers can price and comparison shop if they want to.... if they decide not to then fine, but they should be provided the information to make that choice.

+1

35 years ago, my employer then, a large engineering and aerospace corporation, already saw that medical costs were spiraling out of control. Along with other private employers, it pushed for health care reform in the state via a proposition. I remember that pricing transparency was one of the desired changes. I was young and did not even have my 1st born yet, so did not think much about this subject, nor had any life experience with healthcare to have much of an opinion. Hence, I did not follow it closely to see how the proposition failed, but I recalled people saying that local hospitals and clinics used scare tactics for voters to put their thumbs down on the change.

I do not believe that one price can fit all, when you talk about hospital costs or much else. I do not know exactly how it works in other countries, but an upscale clinic should be allowed to charge more, and they should not be shy to post their prices. If your insurer only allows so much for an operation, but you want to stay in a place that serves filet mignon cooked by the bedside covered by 1000-thread-count sheets and do not mind to pay extra, you should be free to do so. It is no different than some employers allowing a certain per diem for business travel, and if you want to pay extra to stay in a 5-star hotel you are welcome to do so.

 

[Mulligan]

FIFY. Just kidding. No, you are right, that is a potential issue but if you implemented it during a time of high demand/low supply of human capital then employers would have an incentive to try to be fair. I wouldn't even mind mandating that employer's provide an explanation of their expected health care subsidy costs before and after enactment.... mind you, not mandating that they have to make employees whole but rather that they have to disclose what they did so employees and investors can see whether employees were made whole or not. It would be sort of fun to watch. I actually think that many employers would play fair.

My GF works for a large Fortune 500 company with paid for premium with $150 yearly deductible. She has NO CLUE how much she would have to pay monthly for a gold plated plan like that. And she even complains about the deductible!


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[travelover]

No disagreement with you at all, but if this ever happened you know the workers currently receiving this benefit would get the royal shaft without a preparatory greasing. They probably would get half of it added to their salary and the other half would mysteriously disappear into the monthly company cashflow statement!

It would also be an interesting discussion when the old health care premium was added to the base wage and the young single guy realizes that the old family man got a much larger raise simply for having more dependents.

 

[Katsmeow]

I am not sure I follow this concern. Its all about creating unfettered competition across all state lines, and no states should be able to regulate more or less than any other.

That would be great if that was so. But, it isn't so... at least it hasn't been in most of the across state lines proposals that have been made.

Sure, if every state had to regulate insurance companies the same as others then competition across state lines would be fine (in my opinion).

But, in the actual real world, they don't have to do so. States actually do vary tremendously in their regulations of insurers and in how they handle things like rate increases or other consumer protections. Simply allowing insurers to compete across state lines does not change that.

So, in the actual real world, it would be like what happened with credit card companies. A race by some states to regulate the least so as to bring more insurers to that state.

I agree this could be fixed by having minimum standards that would have to be met...but that isn't what is being proposed.

 

[Mulligan]

It would also be an interesting discussion when the old health care premium was added to the base wage and the young single guy realizes that the old family man got a much larger raise simply for having more dependents.

That would be another hornets nest wouldnt it...Equitable distribution of the monies...And no doubt many companies give that kind of bene for family fertility success...


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[candrew]

But ideological stances in the US work against actual solutions.

The problem is that healthcare in the U.S. is treated like any other commodity. We are witnessing the same approach now in public education and to varying degrees, other municipal services like water & public safety.

 

[NW-Bound]

I am not sure I follow this concern. Its all about creating unfettered competition across all state lines, and no states should be able to regulate more or less than any other.

As I mentioned in an earlier post, even in a country like Canada that has universal health care each province has a different set of coverages, requirements, etc... Why don't they all agree on a common set of rules and regulations and pricing?

A place to start would be to study what other countries have done, and the reasons they did it. I suspect that when we dig down and understand all the nuances, we will see that it is not so simple. The devil is always in the detail.

 

[Ian S]

The ACA, imperfect as it is, is a big step in the right direction. What's proposed by those wanting to repeal it strikes me as a huge step backwards. By the time 2017 rolls around, people won't stand for its replacement by something inferior and I think the politicians know that. What we're seeing now is a lot of blather to get primary votes - nothing more.

I would add that at the rate we're going with mergers in the insurance industry, we may end up with single payer anyway!

 

[pb4uski]

The problem is that healthcare in the U.S. is treated like any other commodity. We are witnessing the same approach now in public education and to varying degrees, other municipal services like water & public safety.

Can you elaborate on how you think it should be treated?

 

[sengsational]

Blather for votes...that about sums it up. Talk is cheap.

 

[growing_older]

Perhaps I am not seeing the difference here between ACA (ObamaCare) and this new GOP proposal. Instead of being required to buy insurance and getting a subsidy if your income is low, you would be able to buy insurance from any state and get a voucher that would be more if your income is low.

What is the difference? Is it that there is no requirement to buy the insurance? Does it do away with the minimum coverages and/or limits on medical underwriting? This seems at most a minimal cosmetic change unless there are other big differences not described.

 

[pb4uski]

Perhaps I am not seeing the difference here between ACA (ObamaCare) and this new GOP proposal. Instead of being required to buy insurance and getting a subsidy if your income is low, you would be able to buy insurance from any state and get a voucher that would be more if your income is low.

What is the difference? Is it that there is no requirement to buy the insurance? Does it do away with the minimum coverages and/or limits on medical underwriting? This seems at most a minimal cosmetic change unless there are other big differences not described.

You're missing at least one HUGE difference and while DW and I could pass medical underwriting, I would object to their plan as a matter of principle.

Of course, tax credits won't do much good for people if they can't get coverage because they have cancer or a disability. Obamacare, of course, outright bans insurers from discriminating against people with pre-existing conditions, then makes it up to the companies by requiring every American to get insured, which gives them more healthy (and profitable) customers. Rubio, Walker, and other Republicans would eliminate those rules.

(emphasis added)

Bringing back pre-existing conditions is a dealbreaker in my mind.

 

[scrabbler1]

Perhaps I am not seeing the difference here between ACA (ObamaCare) and this new GOP proposal. Instead of being required to buy insurance and getting a subsidy if your income is low, you would be able to buy insurance from any state and get a voucher that would be more if your income is low.

What is the difference? Is it that there is no requirement to buy the insurance? Does it do away with the minimum coverages and/or limits on medical underwriting? This seems at most a minimal cosmetic change unless there are other big differences not described.

Doing away with the individual mandate is a HUGE difference. Without it, younger, healthier people will opt out of buying insurance and cause premiums to rise. Or, they will become free riders who don't buy insurance until they get sick, another bad outcome.

 

[jim584672]

Perhaps I am not seeing the difference here between ACA (ObamaCare) and this new GOP proposal. Instead of being required to buy insurance and getting a subsidy if your income is low, you would be able to buy insurance from any state and get a voucher that would be more if your income is low.

What is the difference? Is it that there is no requirement to buy the insurance? Does it do away with the minimum coverages and/or limits on medical underwriting? This seems at most a minimal cosmetic change unless there are other big differences not described.

His plan is not a minimal change at all.
Gives a tax credit based on age alone, without consideration of income or resources:
0-17 $900
18-34 $1,200
35-49 $2,100
50-64 $3,000
Brings back consideration of pre-existing conditions, deletes Medicaid expansion, reopens the Medicare donut hole problem, creates high risk pools, removes requirement for insurance which will drive premiums up, children under 26 no longer able to stay on the parents plan, "lawsuit reform" deprives those injured from getting just compensation.

 

[eytonxav]

That would be great if that was so. But, it isn't so... at least it hasn't been in most of the across state lines proposals that have been made.

Sure, if every state had to regulate insurance companies the same as others then competition across state lines would be fine (in my opinion).

But, in the actual real world, they don't have to do so. States actually do vary tremendously in their regulations of insurers and in how they handle things like rate increases or other consumer protections. Simply allowing insurers to compete across state lines does not change that.

So, in the actual real world, it would be like what happened with credit card companies. A race by some states to regulate the least so as to bring more insurers to that state.

I agree this could be fixed by having minimum standards that would have to be met...but that isn't what is being proposed.

Of course that situation does not exist today, but I thought this post was about coming up with alternatives. That would be the best case solution from my perspective.

 

[candrew]

Can you elaborate on how you think it should be treated?

IMO, access to routine, quality healthcare should be treated as a basic human right and not based predominately upon a person's ability to pay.

 

[Big_Hitter]

IMO, access to routine, quality healthcare should be treated as a basic human right and not based predominately upon a person's ability to pay.

I don't see that in the bill of rights

 

[MichaelB]

Best to stay on topic, which is about specific proposals to replace the ACA.

 

[Big_Hitter]

Best to stay on topic, which is about specific proposals to replace the ACA.

agreed - I'm interested in what they are going to do with the 40% "Cadillac" tax - which is the primary funding mechanism for the ACA

also, ACA reporting is about to hit employers and will be particularly onerous for them

these two things could push major legislation

 

[MichaelB]

To clarify, the thread topic is current proposals that have been made and, if enacted, will impact us. The discussion - how these might affect us and what options we have - is interesting and relevant.

There have been many previous threads on what we dislike about the ACA. Most lead to the type of heated discussion that is not related to FIRE or our forum, so let's please stay away from that.

 

[tulak]

agreed - I'm interested in what they are going to do with the 40% "Cadillac" tax - which is the primary funding mechanism for the ACA

also, ACA reporting is about to hit employers and will be particularly onerous for them

these two things could push major legislation

Editing to add: I know this not on topic. I just wanted to share what my employer is doing to avoid the Cadillac tax due to ACA, which I thought might be interesting to others. No responses necessary.

I'm not sure this is true. My employer is going from an HRA to an HSA next year - which I'm happy about - in order to avoid the "Cadillac" tax.

I would assume this would be true for most employers. I'm skeptical many will pay the additional tax, since human nature indicates we are all well conditioned to minimize our taxes. Companies aren't exempt from that condition.