Republican Study Committee, October 22, 2019
Today, the Republican Study Committee released The RSC Health Care Plan: A Framework for Personalized, Affordable Care (click here to download full report). Spearheaded by RSC Chairman Mike Johnson (LA-04), RSC Health Care Task Force Chairman Roger Marshall, M.D. (KS-01), and members of the RSC Health Task Force, the RSC Health Care Plan would protect vulnerable Americans – including those with pre-existing conditions, chronic illness, and serious health issues – while reducing premiums, deductibles, and overall health care costs.
The product of a year of research and stakeholder discussions, the RSC’s approach to achieve more personalized, affordable care is designed to empower patients and doctors rather than bureaucrats and insurance companies.
The RSC Health Care Plan is presented as an alternative to Democrat proposals to double-down on the failing status quo or force all Americans off their current insurance plans – including those with employer-sponsored coverage – and into a one-size-fits-all, government-run health care system.
The RSC Health Care Plan
Enhanced Portability Protections
First, under the RSC plan, movement into the individual marketplace from the employer marketplace would be facilitated by ensuring that individuals do not need to exhaust COBRA (or other continuation) coverage before entering the individual market with portability protections. Employer-sponsored plans are often far broader and more expensive than people need or can afford on their own.
Second, whether a person is moving from an employer plan into the individual marketplace or switching individual plans, they would receive the same coverage protections afforded to a person enrolling in employer-sponsored coverage under pre-ACA HIPAA law. However, if a person does not have twelve months of continuous coverage,121 the person could be subject to an exclusion period of up to twelve months for an existing condition. Lawmakers could also explore ways in which states could be given flexibly in providing these portability protections in the individual marketplace for those with continuous coverage.
To ensure that ample options exist for Americans to possess continuous coverage, short-term, limited- duration plans would count toward periods of continuous coverage under the RSC plan. Additionally, the RSC plan would codify the Department of Health and Human Services’ new rule allowing short- term, limited-duration plans to last for a term of one year (and renewable for up to 36 months). Health care sharing ministry plans would also count toward continuous coverage. However, in order to combat a potential adverse selection issue where individuals with portability protections attempt to switch to a plan with more substantial benefits, carriers should be given the flexibility to apply the continuous coverage requirements on a benefit-by-benefit basis.
Guaranteed Coverage Pools
The RSC plan would provide federal funding for states to supplement the medical costs of eligible high-risk individuals. The RSC plan refers to this mechanism as a Guaranteed Coverage Pool.
More specifically, under the RSC plan, the federal government would make funding available for states to design and operate their own Guaranteed Coverage Pools. States would not be locked into a particular Guaranteed Coverage Pool mechanism, but rather would be given the freedom to use the federal funds to implement innovative, state-centric designs that would ensure everyone in the state’s pool has access to better care than under the ACA.
Federal funding for Guaranteed Coverage Pools would be delivered to states in the form of a grant derived from repackaging the ACA’s individual marketplace subsidies and Medicaid expansion.
Though the potential $17 billion annual price tag135 may not seem ideal, it sets up a sustainable path for the individual marketplace and deters our nation from heading toward a government-run, one-size-fits-all health care system that would cost taxpayers more than $30 trillion over the next decade.
Tax Benefit Equality
The most notable flaw in the tax code as it relates to health care is the inequitable treatment between employer-sponsored and individually purchased health insurance. A person choosing to purchase health insurance with income from their paycheck is at a significant tax disadvantage versus a person receiving employer-sponsored insurance.
The RSC plan proposes a more efficient system that would provide equal tax treatment in the employer and individual health insurance markets. Thus, the RSC plan would give individuals the ability to use health savings accounts (HSAs) to pay for premiums in the individual marketplace.
Unleashing Health Savings Accounts
Beyond allowing individuals to use health savings accounts to pay health insurance premiums, the RSC plan would enact a significant amount of reforms to expand the accessibility and effectiveness of health savings accounts. In particular, the RSC plan would eliminate the requirement that health savings accounts be tied to a high-deductible plan, increase health savings accounts’ maximum contributions, and expand the scope of eligible health care expenditures.
Critically, while the RSC plan would unleash health savings accounts, it would ensure that these accounts are pro-life and do not inadvertently allow a back-door method of subsidizing abortion procedures.
Protecting Medicaid’s Vulnerable Populations
The RSC plan calls on lawmakers to right-size the Medicaid program so that it can remain a sustainable health care safety net for vulnerable populations for generations to come.
The first step to right-sizing Medicaid under the RSC plan is an immediate moratorium on future Medicaid expansions and the institution of a phase-out of the expansion’s enhanced FMAP rate.
Expanding Direct Primary Care
Direct Primary Care is an innovative, affordable, and transparent care delivery system that allows patients to pay a monthly service fee—usually about $60 – $70 per month—directly to a health care provider instead of paying a copay or coinsurance for each visit to a doctor. As Avik Roy has said, “It’s like concierge medicine, but for everyone, including the poor.”
Health Care Sharing Ministries
Health care sharing ministries (HSMs) are faith-based nonprofit organizations whose members share a common set of ethical and religious beliefs and share medical expenses among themselves in accordance with those beliefs.
Association Health Plans
The RSC plan urges codification of the reforms promulgated by the Department of Labor that ensure Americans have greater access to Association Health Plans (AHP).
Health Status Insurance
Traditional health insurance covers your risk of medical expenses in the current year, whereas health status insurance covers your risk that your insurance premiums may rise due to an unforeseen circumstance that may occur in the future. This essentially allows an individual to pay for the option to purchase more comprehensive insurance at a later date. Functions as “health insurance-insurance.”
Short-Term, Limited-Duration Plans
Short-term, limited-duration plans are exactly what they sound like: health insurance plans meant to be used for short periods of time in-between jobs or during other short lapses of health coverage.
The RSC is recommending that states work to remove barriers for telemedicine to be able to innovate and become more prevalent.
Certificate of Need Laws
By restricting new construction of provider facilities, these programs reduce competition, prevent the market from working on its own, and are subject to political influence. For these reasons, the RSC plan urges states to reform or repeal their certificate of need laws.
From the Conclusion
To argue for doubling-down on the status quo is to argue against helping these families and the countless number of other Americans who have fallen through the cracks of the ACA. At the same time, to embrace the Left’s “solution” of a government-run, one-size-fits-all ACA replacement proposal is to ignore the fact that individuals have unique health care needs.
As conservatives, we have joined together to propose another path forward—one that can dramatically improve access to quality, affordability, and choice in the American health care system. We offer a plan that will PROTECT the vulnerable, EMPOWER patients, and PERSONALIZE care. It is a plan that will give Americans, including those with pre-existing conditions, access to coverage options they can actually afford to use, and it will right-size Medicaid so it can remain a sustainable health care safety net for those who truly need it for generations to come.
By Don McCanne, M.D.
The health care plan of the Republican Study Committee might best be characterized as a plan to empower patients to use their own money to personalize their health care. What could be wrong with that?
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