The American health care system, while not as bad as some of its critics make it out to be, is definitely in need of some work.
In 2010, the Democratic Party’s “Affordable Care Act (ACA)” was signed into law. This has been colloquially called “ObamaCare” by supporters and critics alike. We’re almost ten years into this experiment now, and…it didn’t work. Health care is now less affordable than it was before ACA. We’re paying higher premiums for worse insurance plans.
Sure, if you’re one of the beneficiaries — those with low incomes who qualify for the subsidies — it worked out pretty great. And some aspects of the law, like its “preexisting conditions” provisions, are quite popular. But for those of us who have to pay for part or all of our own health insurance premiums, it has mostly been a costly disaster.
For eight years, Republicans promised to repeal the ACA and replace it with something better. Then, when they got power, they didn’t. They spent eight years not bothering to develop a plan. Good work, guys.
Meanwhile, Democrats spent most of that time denying that anything was wrong…or offering vague promises to “improve” the ACA. Now, many prominent Democrats are proposing a “Medicare for All” plan that would completely replace the ACA with an unconstitutional national health care system based upon the existing Medicare system for the elderly. Perhaps they should first talk to some elderly people about how well that system is working for them.
It’s time to really repeal and replace the ACA, and many other federal laws and regulations around health care, and move toward a system that actually empowers the people to pay fair prices for quality care…and empowers the people of the states to decide for themselves what kind of system they want in their state.
A Health Reform Framework
(This is an edited excerpt from an article that originally appeared on Scott Bradford: Off on a Tangent in 2017.)
- All federal laws and regulations pertaining to the health care industry, excluding those pertaining to Medicare, Medicaid, and the military health care system, are repealed.
- Any medical insurance company licensed to operate in any state shall be permitted, without restriction, to offer its products to citizens and residents of other states. Any insurer that chooses to do so, having engaged in interstate commerce, shall be subject to the following. The states are also encouraged to enact similar restrictions on insurers that are not engaged in interstate commerce.
- Individual insurance policies and premiums shall be set uniformly for all customers on the basis of average risks and costs across the individual customer pool. These polices shall be made available to all individuals without regard to their individual attributes or conditions.
- Family insurance policies and premiums shall be set uniformly for all families of equal number on the basis of average risks and costs across the family customer pool, however the premiums for families may not be higher than the premium for individual policies covering the same number of people. These policies shall be made available to all families without regard to the individual conditions or attributes of any members of the family.
- Customers shall have the right to seek medical care from any provider licensed in the state in which it operates, with the costs of said care to be paid by the insurer, less any deductibles and patient portions agreed to under the terms of the policy.
- No insurer may charge any customer more than 10% in additional out-of-pocket costs for care given by a provider who has been deemed by the insurer to be ‘out of network’ versus the cost for the same care provided ‘in network.’
- Upon issuing a policy to any individual or family which, immediately prior to obtaining a policy, shall have had a break in health insurance coverage longer than 120 days, the customer shall have the following options:
- Voluntarily exclude preexisting conditions from coverage for a period of one year.
- Or, pay a preexisting condition surcharge, which shall be equal to no more than 50% of the cost of an individual insurance plan, to cover those conditions until the conclusion of the first year.
- Insurers may, but shall not be required to, provide coverage for elective or medically unnecessary medicines and procedures.
- No insurer may refuse to offer insurance to a customer, nor may an insurer discontinue insurance coverage for a customer, due to any medical condition. Nor may an insurer set any lifetime or annual coverage limits. Nor may any insurer refuse to cover any condition or charge a surcharge for any condition, except as provided by this bill.
- Insurers subject to this section must accept all employer and government insurance vouchers as provided by this bill.
- Any medical facility or provider that accepts payment from insurers operating across state lines, thereby having engaged in interstate commerce, shall be subject to the following. States are also encouraged to enact similar restrictions for providers not engaged in interstate commerce.
- All services and procedures shall be priced uniformly for all customers, whether insured or uninsured, except as provided by this section.
- A facility or provider may enter into contracts with one or more insurers, which may then deem that facility or provider to be ‘in network,’ but the total price of all services and procedures for ‘out of network’ or uninsured customers shall be set no more than 10% higher than those for ‘in network’ customers.
- Any employer that operates across state lines shall provide all of its employees with a health care voucher, which shall be usable toward the cost of any licensed individual or family health insurance plan. No such employer shall offer predetermined health care plans as a benefit of employment in lieu of this voucher. States are also encouraged to enact similar restrictions for employers not engaged in interstate commerce.
- For employees working at least 35 hours per week, the amount of this voucher shall be no less than 60% of the average cost of an individual, full-coverage health insurance plan.
- For employees working less than 35 hours per week, the amount of this voucher shall be equal to the amount provided to full time employees, but prorated to the number of hours worked per week as a proportion of 35.
- This voucher shall not be provided to employees residing in a state that has adopted a ‘single payer’ health care system.
- Via existing state and federal welfare programs, a government health insurance voucher equal to the average cost of an individual, full-coverage health insurance plan shall be provided to all individuals and families below the poverty line. This shall be initially funded by the federal money previously intended for funding the ACA.
- This voucher shall be prorated as income rises above the poverty line, by a formula to be developed by the Department of Health and Human Services, so as to discourage individuals and families from remaining below the poverty line to maintain voucher benefits.
- Over a period of ten years, all federal welfare programs, including this voucher program, and also including the federal insurance exchange (HealthCare.gov), Medicare, and Medicaid, shall be transferred to programs managed and funded by the several states under their own duly-enacted laws and policies.
- This voucher shall not be provided to persons residing in a state that has adopted a ‘single payer’ health care system.
- Per the Tenth Amendment to the U.S. Constitution, the several states are responsible for the regulation of their health care systems. If any of the several states implement a ‘single payer’ or ‘socialized’ health care system for its citizens, it shall be subject to the following restrictions per the ‘interstate commerce’ and ‘full faith and credit’ clauses.
- Any state implementing a ‘single payer’ system shall establish a state-owned and state-funded insurance provider for the purposes of covering all medical costs incurred by its citizens while traveling overseas or to states with market-based insurance systems.
- Any state implementing a ‘single payer’ system shall provide care to any persons within its borders, but may charge a fee, equal to the cost of providing that care, to any nonresident. The nonresident shall then remit payment either directly or via their private, state, or national insurer.
- The veterans’ health care system, its medical facilities, and its employees, along with all funds budgeted for its operation, shall be transferred to the Department of Defense and integrated into the military health care system.
- All veterans shall have access to this combined system for service-related medical treatment, and shall be treated on an equal basis with those currently serving in the armed forces.
- Those currently serving in the armed forces may be prioritized for treatment ahead of veterans, but only to the least extent necessary to maintain full combat readiness, only during times of active war or conflict, and only by the order of the Secretary of Defense.