A new conservative health reform proposal

Lately, we’ve heard lots from the political left on health reform. There is a myriad of so-called “Medicare-for-All” or “Medicare-for-More”, as well as Medicare and Medicaid buy-in proposals. Some states are even considering and advancing their own health reform, including Medicaid buy-in.

 

Furthermore, in the center, there has been some bipartisan consensus, particularly in the Senate Health, Education, Labor and Pensions (HELP) Committee on how to fix the Affordable Care Act (ACA). In 2018, those bipartisan remedies became ensnared in an irreconcilable debate about abortion prohibitions, which incidentally, was unrelated to any of the proposed ACA fixes.

 

This week we saw the first recent new bill from the political right. It’s worth discussing what it includes in order to evaluate Republican priorities in response to the failed attempt to repeal the ACA. Representative Bruce Westerman (AR-4) introduced the Fair Care Act on February 25, 2019 and published an op-ed in the Washington Examiner on March 7, 2019.

 

According to Rep. Westerman’s op-ed, the bill has two goals: “to increase the number of people with health insurance coverage, and to decrease per person health spending.” Here are some highlights from the bill:

 

General

• Offer a limited appropriation “invisible” high risk pool
• Modify age band ratings (which would make insurance more expensive for older enrollees and cheaper for younger enrollees), but also increase premium assistance based on an age/income formula
• Support proposals to sell cheaper and less comprehensive insurance, some with increased health savings accounts and reduced cost-sharing
• Repeal many ACA taxes and penalties, including the employer mandate to provide coverage
• Address concerns about drug pricing and competitive practices
• Establish patient ownership of digital health data, modify Stark Law to address value-based purchasing, and improve Medicare telehealth reimbursement
• Increase provider competition through tightening antitrust laws; eliminating Certificate of Need (CON) and Any Willing Provider laws; repeal Accountable Care Organization (ACO) incentives; and increase price transparency

 

States and Medicaid

• Increase flexibility in 1332 waivers and state option to pursue a block grant; If a state pursues block granting, the federal government would pay premiums for individuals under 100% of the poverty level
• Offer an option to increase open enrollment timeframes to two- or three-year periods for state-based marketplaces
• Pilot programs for selling insurance across state lines
• Give states option to hire a vendor to conduct Medicaid eligibility redeterminations
• Eliminate the safe harbor provisions for state Medicaid provider taxes gradually

 

Medicare and Federal Employees

• Eradication of the Federal Employees Health Benefits Program, putting federal employees, like members of Congress, on the federal marketplace and those eligible for Medicare solely on Medicare
• Technical changes to Medicare’s eligibility and reimbursement, including site neutral payments

 

There are some old priorities (e.g., high risk pool, selling insurance across state lines, block granting Medicaid), but there are also some new ideas from a conservative lawmaker. Even with no clear path to pass both chambers of Congress, we will keep an eye on all new proposed legislation.