Health Care Reform - Benefield 08-09

What’s Not to Like About National Health Care : 

What’s Not to Like About National Health Care

Government Option : 

Government Option More enrollees in current and new programs Government-run insurance “self-financed” with premiums Trojan Horse to Single-Payer Co-Ops not any better Expanded eligibility for Medicare/Caid Automatic Medicaid Enrollment

Government Rationing : 

Government Rationing Government funded comparative-effectiveness research to impose practice guidelines on providers, starting with gov’t programs. “Trim” Medicare Costs – not sure how Must seek federal approval for any expansion of hospital, adding additional beds, etc.

Subsidies for Private Insurance : 

Subsidies for Private Insurance Middle-class quasi entitlement Establishment of a National Health Insurance Exchange (see Clinton plan of 1993, Massachusetts program) Would serve as a clearinghouse of health insurance Would evaluate plans, costs, and services Market government-run public option insurance plans

Taxes : 

Taxes Tax the Rich - Surcharge Tax the Uninsured Tax Employers w/out qualified plan Fair Share Fee on all Health Insurance Plans Proposed: Tax Benefits Proposed: Tax Soda The Big One = TBD

Mandates : 

Mandates Individual Mandate/Tax Employer Mandate/Tax Guaranteed issue Community rating Coverage Mandates

What’s Wrong with Medicare/Medicaid? : 

What’s Wrong with Medicare/Medicaid? Costs well above expected Rising, consumer greater portion of federal/state budget Going bankrupt, threaten to consume entire budget if not reformed Limited Coverage, low quality of care Underpay doctors/hospitals Many doctors refusing to take new patients Longer wait periods Cost shifting

Laffer Study : 

Laffer Study

Federal Proposals : 

Federal Proposals Kennedy-Dodd bill Individual Mandate and Employer Mandate with a penalty tax Modified Community Rating, and Guaranteed Issue Slacker mandate till 26, and no limits on benefits New bureaucracy to define essential benefits. Expands eligibility for Medicaid, subsidies up to 400% FPL, and increases the reimburse rates for Medicare No self insurance for businesses under 250 employees States set up gateways and old plans exempt from new regulations

What Should We Do? : 

What Should We Do? Equal tax treatment Interstate competition in health insurance Allow mandate-lite, limited insurance plans State high risk pool Medicaid/Medicare Reform – savings acct. model ,credits to buy private insure, (block grant to state) Tort Reform

Federal Proposals : 

Federal Proposals Paul Ryan bill Shifts ownership of health care to individuals by offering a tax credit of $2,500 ($5,000) for families to purchase coverage in any state and keep if your job changes. Transparency in health care price and quality data Reforms high risk pools and flexibility to states to structure Medicaid Limits Medicare for those 55 and under to a maximum payment of $9500 based on income, inflation, and risk . MSAs for all enrollees

Federal Proposals : 

Federal Proposals Jim DeMint bill Funded by terminating TARP and returned bailouts $2,000 voucher for those who do not have EPI (2007 average insurance cost $1,896) Encourages Health Savings Accounts through tax policy Allows individuals to purchase health insurance plans in any state. Provides block grants for states to cover those with pre-existing conditions. Malpractice cap on economic damages and access to price information prior to treatment.

Health Care Websites : 

Health Care Websites CPRights.org JoinPatientsFirst.com Healthcare.Cato.org FixHealthcarePolicy.com PatientsUnitedNow.com HealthcareHorserace.com CAHI.org Galen.org CHCChoices.org NCPA.org CommonwealthFoundation.org

Nathan Benefield : 

Nathan Benefield Director of Policy Research Commonwealth Foundation 225 State Street, Suite 302 Harrisburg, PA 17101 717-671-1901 nab@commonwealthfoundation.org CommonwealthFoundation.org