Dr. Coburn Unveils Obamacare Replayment – Patient CARE Act – with Senators Burr and Hatch

Senator Tom Coburn
January 27, 2014

Today, U.S. Senators Richard Burr (R-N.C.), Tom Coburn, M.D. (R-Okla.), and Orrin Hatch (R-Utah) unveiled the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act – a legislative plan that repeals Obamacare and then replaces it with common-sense, patient-centered reforms that reduce health care costs and increase access to affordable, high-quality care.  In contrast with Obamacare and its government centered mandates and regulations, the Senators’ proposal empowers the American people to make the best health care choices for themselves and their families.


The Patient Choice, Affordability, Responsibility, and Empowerment Act

January 2014

(All section numbers of the proposal are listed, with each followed, in parentheses, by a brief and admittedly biased description by Don McCanne.)

Title 1: Repeal the President’s Health Care Law

Section 101: Repeal Obamacare

(The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act would be repealed with no proposal as to how the many provisions already implemented would be undone.)

Section 201: Adopt Common-Sense Consumer Protections

(The Act would prohibit lifetime limits, guarantee renewability with restrictions, prohibit unfair terminations, and change the aged-based premium ration to 5:1, from 3:1, resulting in higher premiums for older individuals.)

Section 202: Create a New Protection To Help Americans With Pre-Existing Conditions

(Individuals with pre-existing conditions would be guaranteed coverage but only if that coverage were continuous. Lapses in coverage – an inevitability for some – would subject individuals to medical underwriting, making plans unaffordable for those with pre-existing conditions.)

Section 203: Empowering Small Business and Individuals with Purchasing Power

(Individuals and employees of small businesses would be eligible for tax credits to help purchase coverage, but these credits would be lower than the ACA subsidies which are already inadequate for many.)

Section 204: Empowering States With More Tools to Help Provide Coverage While Reducing Costs

(States could use auto-enrollment for individuals who do not select a plan, though the individual has the option to refuse the plan – an arrangement that is sure to leave tens of millions uninsured.)

Section 204 (sic): Expand and Strengthen Consumer Directed Health Care

(Some restrictions would be removed from health savings accounts, but there are no new proposals to help fund these accounts. An empty HSA is of little benefit to patients who cannot pay the high deductibles of the HSA-eligible plans.)

Title 3: Modernize Medicaid to Provide Better Coverage and Care to Patients

Section 301: Transition to Capped Allotment to Provide States with Predictable Funding and Flexibility

(Federal funding of state Medicaid programs would be changed to a system that would have an impact similar to block grants, plus the states could issue the equivalent of vouchers allowing Medicaid beneficiaries to purchase private plans. This would further reduce federal funding to this already underfunded program, shifting more costs to state governments, and, even worse, to the Medicaid beneficiaries who have incomes near or below poverty.)

Section 302: Reauthorize Health Opportunity Accounts To Empower Medicaid Patients

(Health Opportunity Accounts are health savings accounts for Medicaid patients. To show how ridiculous this concept is, a demonstration program was set up that would allow ten states to establish them, but only South Carolina did, and only five patients enrolled.)


Section 401: Medical Malpractice Reforms

(Perpetuates the fiction of junk lawsuits, although a compensation system modeled after workers’ comp is suggested.)

Title 5: Increasing Price Transparency to Empower Consumers and Patients

Section 501: Requiring Basic Health Care Transparency to Inform And Empower Patients

(Empowering patients to be price shoppers perpetuates the fiction that there is a price-sensitive market in health care delivery. As Kenneth Arrow explained to us, there isn’t.)

Title 6: Reducing A Distortion in the Tax Code That Increases Health Costs

Section 601: Capping the Exclusion of An Employee’s Employer-Provided Health Coverage

(They would reduce, rather than eliminate, tax expenditures for employer-sponsored plans – still deductible to the employer, but partially taxable to the employee, thereby increasing workers’ costs for health care.)


The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act is a white paper that is being touted as the “Replace” part of the Republican Repeal and Replace answer to the Affordable Care Act (ACA). It has some similarity to ACA in that it would leave in place much of our dysfunctional health care financing system. Although some of the measures of ACA are beneficial, they are far too feeble compared to what we actually need. CARE would set us even further behind, leaving tens of millions more without insurance, and exposing insured patients to even greater costs when accessing the health care that they need.

This is another “if we don’t enact this, we’ll end up with single payer” proposal. Let’s hope so.