Letter to The Editor: In Defense of Repeal and Replace

Adam from Little Rock, Arkansas

On June 28th, your website published an article about a new proposal to repeal Obamacare by Joe Melisi. In your article, Mr. Melisi describes the proposal as “egregious” and full of “detrimental policies”. I would like to bring to your attention the mischaracterization of the proposal by Mr. Melisi, as well as remark on a few areas of common ground. 

On Tuesday, June 19th the Health Policy Consensus Group (HPCG), a coalition of health policy experts and think tank leaders, released a summary of their new healthcare proposal which will likely become the backbone of new Republican legislation to repeal Obamacare. 

I encourage all readers of Your Take Politics to review the proposal carefully, but to quickly summarize (and grossly generalize) its contents: this plan would redirect federal funds from Medicaid expansion, and insurance company subsidies used to lower co-payments and deductibles (~$7 billion), to the states as a direct block grant to help Americans afford private insurance and gain access to the doctors and coverage they choose. 

At least 50% of the block grant goes toward supporting people’s purchase of private health coverage, at least 50% goes toward coverage of low-income people (these two categories will overlap), and the rest will be used to offset the cost of high-risk patients to make sure they get the care they need without driving up premiums for everyone else. This provision is especially important as it will ensure coverage is protected for people with pre-existing conditions; contrary to Mr. Melisi’s belief.

This proposal would negate the Obamacare benefit mandates, minimum loss ratio requirement, single risk pools, and the 3:1 age rating requirement. Albeit these policies had good intentions, but they are responsible for much of the downward spiral of the ACA.

Obamacare encourages people to wait to buy coverage until they become ill. When the insurance pool becomes bloated with expenses, and young healthy people are discouraged from joining due to high premiums, insurers take a hard hit. It’s no surprise that insurers continue to remove their plans from the Obamacare exchange. (In Alabama, for instance, Blue Cross Blue Shield was the only insurer participating in the exchange in 2017, and it’s spending $1.20 for every $1 it collects in premiums). Currently, half of those buying coverage in the Obamacare exchanges have only one insurer to choose from.

The insurers who have chosen to remain in the marketplace have no other choice but to raise their premiums. Average premiums for individual health insurance rose 105% in the first four years after Obamacare took effect — from $232 to $476 a month on average. Quality of care within Obamacare has also suffered. Plans offered on the marketplace often list prestigious hospitals and doctors as out-of-network. Houston’s MD Anderson Cancer Center, which was named America’s best cancer-care hospital by U.S. News & World Report in 13 of the past 16 years, is off-limits to Texans; the world-renown Mayo Clinic is also out-of-network for Minnesotans. The ACA has made healthcare more expensive and reduced choice. 

I was glad to see Mr. Melisi called himself a believer in the power of private enterprise, however his disapproval of health saving accounts (HSAs) confuses me. In brief, HSAs are typically packaged with high-deductible health insurance policies. You or your employer can contribute pre-taxed dollars to the account; funds that are withdrawn must be spent on health costs (deductibles, prescription drugs, copayments, glasses, and even ambiguous foot procedures.)If you don’t use all the funds that year, it serves as an interest-bearing nest egg that rolls-over and grows until you retire. The policy proposal by HPCG wants to double HSA contribution limits so consumers can practically pay off their deductible limit with the HSA.

Those opposed to HSAs, such as Mr. Melisi, often claim this is a tax haven for the rich. First-off, why must certain individuals feel an urge to tax every penny made by Americans, even funds specifically restricted for health expenses. Regardless, the contribution limit to HSAs is currently $3450 for individuals and $6900 for families; this is not some millionaire stow-away scheme. Secondly, HSAs are for everyone. By the end of 2017, there were at least 22 million HSA’s in the U.S. HSAs have helped put consumers directly in charge of their health-care purchases. This drives competition, which leads to lower prices for everyone. 

I’ll give Mr. Melisi credit that Medicaid buy-in option is a newer idea from democrats which has yet to receive much attention. I may be keener toward the idea if it wasn’t for Medicaid’s reputation of providing lower quality care which severely limits access to physicians, particularly specialists. In the state which Your Take Politics is published, Illinois, 752 Illinoisans on the state’s Medicaid waiting list have died awaiting care since the Obamacare Medicaid expansion. In 2016 there were 18,701 Illinoisans on the state’s Prioritization for Urgency of Need for Services Medicaid waiting list. Every time government healthcare grows, so does rationing and wait times; just ask the Canadians. 

I’d like to end by remarking on few areas where I think both sides of the aisle can agree. Any future legislation should prohibit insurance companies from canceling your coverage if diagnosed with a serious illness; there should be limits on how high insurance premiums can be increased if diagnosed with a serious illness; and the ability for dependents (children) to remain on a parent’s healthcare plan until 26 should remain. Lastly, A bipartisan group of state lawmakers in Colorado are currently working to build support for the Comprehensive Health Care Billing Transparency Act. This would allow Coloradans to see the true price of any health service before treatment, and hospitals would have to disclose base fees for specific services. I fully support this measure and believe it’s something Mr. Melisi, and Your Take Politics readers, should keep their eye’s out for. If passed, it could have a huge effect on the affordability of healthcare in America.