Saturday, February 5, 2011

How would the House replace the healthcare reform they repealed?

(Originally posted on the National Physicians Alliance blog January 23, 2011)


Somewhat lost in the fuss around the House of Representative's actions to repeal the Patient Protection and Accountable Care Act (PPACA) was the fact that the House's Republican leadership actually submitted its own proposal for reforming health care.  Last year, now-Speaker John Boehner sponsored an amendment to H.R. 3962 (the "Affordable Healthcare for America Act").  This is currently the only legislation the GOP has submitted to take the place of the PPACA, and therefore it is important to see what this alternative offers.

Fortunately, the Congressional Budget Office (CBO) has completed a preliminary review of the Speaker's proposal.  As it currently stands, the supposed replacement for the PPACA will make minimal changes in the current state of the United States health care system.  The proposal would reduce insurance premiums in the large group market by 0-3%, and by 5-8% in the individual insurance.  The proposed legislation would also reduce the number of non-elderly Americans who lack insurance by 3 million people between 2010-2019 (leaving 52 million non-elderly Americans uninsured).

To do this, the proposal would reform insurance markets by allowing insurers to sell products across state lines.  This would allow the state with the most lenient requirements to essentially dictate the market, as the cheapest plans with the fewest benefits would appeal to employers and others attempting to reduce costs.  The plan would also reform health spending accounts and work to enact malpractice tort reform.

Nowhere in the plan is there any indication of reforming insurance company practices of denying care on the basis of preexisting conditions, or of ending the policy of rescinding health coverage once an individual starts making use of the coverage they purchased.  Nor does the law continue such popular provisions of the PPACA as closing the Medicare Part D "doughnut hole" or allowing parents to include adult children on their insurance until age 26.  These are provisions that have broad popular support, and that the Republican-controlled House took away when they voted to repeal the PPACA.
As it stands, the proposed replacement for the PPACA would be laughable if it weren't so sad.  The proposed legislation would undercut numerous patient protections from insurance company misconduct while doing nothing to increase access to health care and making minimal changes in the cost of obtaining health insurance coverage.

It's a good thing that the PPACA is still law, and will remain law, despite the House's symbolic vote for repeal.  The alternative would be a disaster.

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