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In the midst of January’s State of the Union Address, President Barack Obama exalted the miniscule benefits of his signature health care legislation.  He then transitioned to a defensive position, challenging critics and Republican members of Congress to cough up a better alternative to the extant black letter law.

What about the sheaf of market-oriented alternatives that have been floating around in Congress for the past decade?  You can click here to read Chris Conover’s Forbes article with more in-depth information on the matter.   

Moreover, on the eve of the president’s latest State of the Union Address, three Senate Republicans released an Obamacare alternative proposal.  The Patient Choice, Affordability, Responsibility, and Empowerment Act (CARE) sponsored by Republican Senators Richard Burr (NC), Tom Coburn (OK), and Orrin Hatch (UT) seeks to execute the same goals as Obamacare: lower health care costs, fix the pre-existing condition dilemma, and reduce the number of uninsured Americans.  A key difference, however, is that the CARE Act operates on incentives, not mandates.  Carrots, not sticks.  It does this by injecting consumer-driven principles and patient choice into the health care delivery system.     

Listed below are just a few of the many consumer-driven, semi market-oriented provisions of the CARE Act:

  • The CARE Act would repeal Obamacare exchanges and extirpate both the employer and individual mandates. Health insurance plans would not be required to include the 10 essential health benefits like current health insurance exchange plans.   
  • A tax-credit would be distributed to individual policyholders and employees of businesses with less than 100 workers who make an income of less than 300% FPL ($35,010 for an individual).  The tax-credit would be distributed directly to the consumer — not the insurance company.
  • If an individual did not enroll in a health plan, that person could be auto-enrolled in a high-deductible plan where the premium matches the tax-credit amount.  If so desired, that person could still opt out of coverage. 
  • A one-time open enrollment period would allow the uninsured and those with pre-existing conditions to purchase coverage without insurers being able to adjust rates according to one’s health status.    
  • Policyholders who maintained continuous coverage for at least 18 months would be allowed to switch plans and not be denied or burdened with skyrocketing premiums due to a change in health status.   

The CARE Act does not come without criticism, however.  Thomas Miller of the American Enterprise Institute has written a thought-provoking and insightful paper on some of the proposal’s loosely defined terms.  He also questions how some aspects of this alternative will be faithfully executed and properly financed.  It’s worth a read. 

Putting that aside, if the ideas outlined above cannot disabuse the liberal claim that Republicans have no Obamacare alternatives, an entire conference devoted to Obamacare alternatives was held last week in Washington, D.C.  A multitude of consumer-driven alternatives were presented, each with their own nuances.  

For instance, John Goodman, president of the National Center for Policy Analysis, suggests that everyone receive a universal tax credit for the purchase of health insurance.  Any tax credits not used for health coverage will be funneled to local safety net institutions providing services for which the uninsured cannot pay on their own.

Moreover, the 2017 Project would not auto-enroll anyone in a plan and would not limit the tax-exclusion for employer-sponsored insurance as the CARE Act would.  The 2017 project would offer an age-adjusted tax-credit to individuals interested in purchasing health insurance through the individual market.  A $900 tax credit would be available to every child, as well.  And, for those who do not use the full tax-credit amount, the remaining portion could be deposited into a health savings account (HSA).  Furthermore, this proposal enables states to allocate annual funds to run high-risk pools for individuals with costly, chronic medical conditions. 

Game on, Mr. President.   

Click here for the Health Update archive.

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