Congress is Set to Repeal Obamacare: What Should Replace It?

The House is voting on a reconciliation bill that would repeal much of Obamacare. It’s expected to pass easily – and be vetoed by President Obama. Before we discuss what should replace Obamacare it would be a valuable exercise to revisit what needs to be repealed.

• The employer mandate has to go. It’s hurting the very people it was designed to help.
• The individual mandate has to go. It’s forcing people to buy something they don’t want.
• Regulations guaranteeing coverage regardless of health status are not sustainable. Premiums are reaching the stratosphere and there is a perverse incentive to game the system.

Representative Tom Price reports a bill with a proposal to replace Obamacare will soon follow. The following are some of the elements that a new Obamacare replacement bill should include.

• The open-ended tax exclusion should be converted to a fixed sum. This could be adjusted for age, health status or some other factor. But the government should subsidize core needs not marginal spending on Cadillac plans.
• Community rating needs to be used to create beneficial incentives; not increase cross-subsidies. The right to buy insurance at modified community-rated premiums needs to be conditioned on continuation coverage. Guaranteed renewability would not allow people who spend years without coverage and expect others to subsidize their decisions.
• Americans deserve the right to purchase the coverage of their choice; not the coverage Obamacare proponents believe Americans should have. This means affordable coverage with limited benefits, high deductibles or coverage that rewards them for taking care of their health if that’s what consumers want.
• Americans should be protected from surprise medical bills – ones where patients cannot ascertain prices in advance or whether the doctor that administers anesthesia is even in their network.
• The federal government should grant states the flexibility to design Medicaid programs that meet states’ needs. The federal government should not match state Medicaid funds. Rather, it should negotiate a block grant and a state contribution; and make states pay for all cost overruns. States should have the authority to design innovative Medicaid benefits, where some beneficiaries pay premiums, experience nontrivial cost-sharing, pay a penalty for inappropriate emergency room use and have work requirements. Moreover, states should have the authority to kick beneficiaries off the Medicaid rolls who break eligibility rules.

These are just a few of our ideas. What are your thoughts? Give us your comments and tell me what have we have missed? Source: Health Policy Blog]]>