Health Care In America: The Republican Alternative

Before I begin the review of the Republican alternative to HR 3962, let me just say one thing.

It was so nice reading a piece of legislation that actually made sense the first time I read it. I didn’t have to cross reference hundreds of different pieces of legislation to figure out what the bill actually said, and I didn’t feel like the text of this amendment was running me in circles.

The Republican alternative to HR 3962 is actually an amendment to the bill. The key being “an amendment in the nature of a substitute”.

Now, before anyone starts stomping their feet and having a hissy fit, I think we all know that Nanny State Nancy will never allow this amendment to come up for a vote, even if she has the votes to defeat it. The last thing she wants is to have this 219 page amendment read on the House floor.

Why? Because it actually makes sense. It isn’t bloated with hundreds of tax hikes, it has no hidden agenda. It simply does (and is) what the title says, “Common Sense Health Care Reform and Affordability Act “. As far as I can tell after reading the bill, it is common sense, it does reform health care, and according to the non-partisan Congressional Budget Office, it does reduce the deficit.

Let’s begin the review.

Division A

Section 101 begins on page 4 and establishes universal access programs for every State and ensures that all Americans, even those in the “high risk” pool have affordable access to health care.

IN GENERAL. – A qualifying State high risk pool described in this subsection means a current section 2745 qualified high risk pool that meets the following requirements:

(A) The pool must provide at least two coverage options, one of which must be a high deductible health plan coupled with a health savings account.

(B) The pool must be funded with a stable funding source.

(C) The pool must eliminate any waiting lists so that all eligible residents who are seek­ing coverage through the pool should be allowed to receive coverage through the pool.

(D) The pool must allow for coverage of individuals who, but for the 24-month disability waiting period under section 226(b) of the Social Security Act, would be eligible for Medicare during the period of such waiting period.

(E) The pool must limit the pool premiums to no more than 150 percent of the average premium for applicable standard risk rates in that State.

(F) The pool must conduct education and outreach initiatives so that residents and brokers understand that the pool is available to eligible residents.

(G) The pool must provide coverage for preventive services and disease management for chronic diseases.

This section concluded within seven pages. I had to read hundreds of pages in Nancy Pelosi’s HR3962 before I could ascertain that the bill specifically allowed waiting lines.

Section 102 eliminates certain requirements for guaranteed availability in individual markets by extending existing HIPAA protections and improving protections for Americans with pre-existing conditions.

Section 103 prohibits any health insurance plan from setting arbitrary annual or lifetime spending caps, which will help those with chronic diseases or some sort of catastrophic medical emergency.

Section 104 prohibits health insurance companies from unlawfully canceling health insurance coverage. HR3692 has no such guarantee. In fact, the only time HR3962 mentions the word cancellation is in reference to loan cancellations.

The remainder of Division A covers topics which will make it easier for consumers to find and compare health insurance plans, make it easier for States to cut health care costs, and to reduce the amount of forms and transactions in health care administration.

Division B

The first few sections of Division B begin by cutting the costs and expanding the access of health insurance for small businesses. Section 201 sets the rules for governing association health plans, Section 202 clarifies single employer arrangements, and sections 203-205 establish the enforcement provisions of those plans and stakes out the cooperation between Federal and State authorities regarding association plans.

Section 211 requires all health care plans to extend coverage of dependents up to age 25, Section 212 allows for automatic enrollment in employer health care plans but it does not require the employee to accept it, and Section 221 is the coup de grace of the Republican alternative. It opens up the health insurance market across state lines.

(1) PRIMARY STATE. – The term ‘primary State’ means, with respect to individual health insur­ance coverage offered by a health insurance issuer, the State designated by the issuer as the State whose covered laws shall govern the health insurance issuer in the sale of such coverage under this part. An issuer, with respect to a particular policy, may only designate one such State as its primary State with respect to all such coverage it offers. Such an issuer may not change the designated primary State with respect to individual health insurance coverage once the policy is issued, except that such a change may be made upon renewal of the policy. With re­spect to such designated State, the issuer is deemed to be doing business in that State.

(2) SECONDARY STATE. – The term ‘secondary State’ means, with respect to individual health insurance coverage offered by a health insurance issuer, any State that is not the primary State. In the case of a health insurance issuer that is selling a policy in, or to a resident of, a secondary State, the issuer is deemed to be doing business in that secondary State.

This section alone will reduce the cost of many health insurance plans across the nation. Before I was laid off in January, my employer was based in Maryland, and because we live here in Georgia our health insurance costs for the employer based plan was extremely inflated. I’m sure this provision alone will save the American public (and their employers) billions of dollars each year.

Section 231 and 232 expand current tax credits for IRAs and 401Ks to Health Savings Accounts (HSAs), and allow for premium payments from those HSAs under certain conditions.

Division C

The sections in Division C deal with medical liability reform by setting a statute of limitations for claims, capping non-economic damages to $250,000, limits punitive damages, and protects States with existing medical liability laws. No provision within this division of the bill limits the economic damages a claimant may receive. In fact, Section 302 makes sure of that.

In any health care lawsuit, nothing in this title shall limit a claimant’s recovery of the full amount of the available economic damages, notwithstanding the limitation in subsection (b).

Subsection B of Section 302 sets the non-economic limit of damages to $250,000. Remember, the largest component of many liability cases are the economic damages.

Division D

This division explicitly prohibits the federal government from intervening with the treatment process.

Section 401 states,

Nothing in this Act shall be construed to interfere with the doctor-patient relationship or the practice of med­icine.

Section 402 repeals section 804 (the Federal Coordinating Council on Comparative Effectiveness Research) of the American Recovery and Reinvestment act to prevent any possibility that the federal government could ration health care based on costs.

Division E

Section 501 provides monetary incentives for prevention and wellness programs. In other words, if employees participated in standards-based wellness programs, employers could offer specific discounts of up to 50% on their health care plan premiums.

Division F

Section 601 increases funding for the Health and Human Services Office of the Inspector General and the Health Care Fraud and Abuse Control program.

Section 602 explicitly prohibits any federal funding from being used to pay for abortions,

No funds authorized or appropriated by federal law, and none of the funds in any trust fund to which funds are authorized or appropriated by federal law, shall be ex­pended for any abortion.

and it also prohibits funding for health benefits plans that cover abortion.

None of the funds authorized or appropriated by federal law, and none of the funds in any trust fund to which funds are authorized or appropriated by federal law shall be expended for a health benefits plan that includes coverage of abortion.

This section does remove that limitation in a couple of specific cases,

(1) if the pregnancy is the result of an act of rape or incest; or

(2) in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is per­formed, including a life-endangering physical condi­tion caused by or arising from the pregnancy itself.

and explicitly allows States to offer a supplemental plan which could cover abortion.

Nothing in this chapter shall be construed as prohibiting any individual, entity, or State or locality from purchasing separate supplemental abortion plan or coverage that includes abortion so long as such plan or cov­erage is paid for entirely using only funds not authorized or appropriated by federal law and such plan or coverage shall not be purchased using matching funds required for a federally subsidized program, including a State’s or locality’s contribution of Medicaid matching funds.

This section also prohibits government discrimination against individual and institutional health care providers.

(a) IN GENERAL. – No funds authorized or appropriated by federal law may be made available to a Federal agency or program, or to a State or local government, if such agency, program, or government subjects any institu­tional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.

(b) HEALTH CARE ENTITY DEFINED. – For purposes of this section, the term ‘health care entity’ includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.

In other words, if a doctor has a moral or religious objection to providing abortion services, he cannot be discriminated against at the federal, state, local level.

I have one question with this section. Are pharmacists covered as “health care professionals”?

Sections 603 and 604 improve enforcement of Medicare payment provisions and strengthen Medicare provider enrollment standards.

Section 605 establishes an expansion of the Medicare and Medicaid databases to track banned providers across state lines. Many providers, when they get into trouble in one state, simply move to another state to avoid the mess. This would no longer be possible under this provision of the Republican alternative to HR3962.

The Secretary of Health and Human Services shall provide for increased coordination between the Administrator of the Centers for Medicare & Medicaid Services (in this section referred to as ”CMS”) and its regional offices to ensure that pro­viders of services and suppliers that have operated in one State and are excluded from participation in the Medicare program are unable to begin operation and participation in the Medicare program in another State.

Division G

The remaining sections of the amendment cover the FDA approval process and expedites the way in which biosimilar drugs will be available on the market when an innovator’s product’s term of patent expires. This will allow quicker access to affordable medications and lower the cost of every health insurance plan that makes them available.

And with that, my review of the 219 page Republican amendment in the nature of a substitution to HR 3962 is complete. It’s short, it’s blunt, and it would do exactly what it says it will do, if it ever got the chance of reaching the House floor.

While many people will be disappointed that this amendment does not raise everyone’s taxes and it doesn’t place their children in a life of servitude to pay the costs of providing health care, this amendment does take some simple, positive steps to true health care reform in our country.

We don’t need a total overhaul of our health system (or our tax system for that matter), but our system does need a few tweaks. The items listed in the Republican amendment tweak our current system by reducing health coverage costs for every American, while reducing the federal deficit by doing so.

You can follow the progress of the Republican amendment (and read some scary reports on HR3962) at the GOP Health Care website.

Finally, we get a real start to the solution for health care reform, and Nancy Pelosi is going to bury it.