" I believe Obamacare will have significant, detrimental effects on our health care and on our nation. Many people are already seeing higher insurance premiums, and I have personally talked with several doctors who have decided to retire or are considering retirement. The problems with its website are just the tip of the iceberg of problems to come. "
Need for Health Care Reform
Although the Supreme Court has ruled the individual mandate is constitutional, I strongly believe that the health care bill was a mistake and that it will adversely affect health care for most of the people in our area and around the country. The new taxes, such as the one on medical devices, the Medicare cuts, and the mandates will mean higher premiums for everyone and more difficulty in finding providers. Therefore, I support repealing that bill and starting over.
The cost of health care and of health insurance is still too expensive for too many Americans. At the same time, close to 84 percent of Americans are currently covered by health insurance. Instead of upending our entire health care system, we need to look for ways to expand access to care and health insurance coverage for the remaining 16 percent while we maintain coverage for those that want to keep it. And we need to find ways to reduce the cost of health care and improve the delivery of health care for everyone.
We should take our time to understand the consequences of any legislative change. As Congress continues to look at our nation’s health care system, I have outlined the main principles that I believe should guide any reform. I have also listed some of the top policy options with explanations of each which Congress can consider. These principles and policy options do not solve – and are not intended to solve – all of the problems in health care. But each of them could make a significant difference to improve the quality and length of life for many Americans.
Five Principles of Health Care Reform
- Improve Access to Care and Expand Health Insurance Coverage
- Lower the Cost of Providing Health Care
- Promote Patient Choice and Competition
- Strengthen Medicare and Medicaid
- Allow States Flexibility to Better Tailor Reforms
Ten Policy Options to Reform Health Care
1) End Health Insurance Tax Discrimination
- Current law does not tax people who obtain insurance through their job for the value of that insurance. Since the full cost of the insurance plan is excluded from gross income for figuring tax liability, many people are unaware of how much their health insurance actually costs. Additionally, this type of tax benefit is not available to those who have to purchase insurance on their own, such as those who are self employed or those whose employers do not offer coverage.
- We should reasonably cap the existing employer tax benefit and use the savings to extend this benefit to everyone including those who have to purchase insurance on the individual market via an advanceable and refundable tax credit. This credit will help increase portability and give individuals greater flexibility to help purchase insurance plans not tied to their work.
2) Increase Insurance Portability for Individuals
The “Health Insurance Portability and Accountability Act (HIPAA) of 1996” provides “portability” protection that reduces or eliminates the period during which no coverage is provided for a preexisting medical condition when individuals switch to and from group health insurance plans. These protections currently apply to a person that moves from one group health plan to another, from a group health plan to an individual policy, or from an individual policy to a group health plan.
Congress should extend similar protections for those moving from one individual policy to another individual policy to promote stability, choice, and portability. Congress should also examine the requirement that COBRA or other continuation coverage, if available, must be exhausted before a person can get HIPAA protections when moving from a group plan to an individual policy.
3) Promote Health Insurance Exchanges with State Flexibility
- The new health care law required states to set up insurance exchanges by 2014. If a state fails to do so, the law directs the Secretary of Health and Human Services to establish and operate an exchange for the state.
Insurance exchanges can be a helpful tool to enable consumers and businesses to choose a health care plan that best fits their needs. Instead of mandating state-run exchanges, we should promote the creation of both public and private exchanges that have the ability to compete and operate according to the needs of its state’s citizens and businesses.
4) Remove Market Barriers to Purchasing Health Insurance Across State Lines
- Insurers can only sell policies in states where they are licensed to do so. This restriction limits the number and types of policies available to an individual or group. We should allow people to purchase health insurance across state lines. Removing this barrier will increase patient choice, improve competition, and allow individuals to better find a plan that suits his or her needs.
5) Ensure Access for Patients with Pre-Existing Conditions
- It can be hard for those with a pre-existing condition to obtain health insurance. They should not be left without coverage. As well as providing HIPAA’s protections to those buying insurance in the individual market, we should expand state high-risk pools and reinsurance programs to help reduce the cost of coverage. We should also examine annual and lifetime spending caps and prevent insurers from dropping your coverage solely because you become sick.
6) Enact Medical Liability Reform
- Medical liability for physicians can increase the cost of health care directly through premiums and indirectly by increasing the numbers of tests and procedures to protect against future lawsuits. Medical malpractice insurance premiums cost over $10 billion a year, and a recent analysis put the estimate of the total cost of defensive medicine at over $45 billion in one year.
- In March of 2012, the House passed a bill, H.R. 5, to reform medical malpractice laws. The bill places a $250,000 cap on noneconomic damages, which is similar to the limit in Texas. It also limits attorney’s fees and establishes a statute of limitations for filing health care lawsuits. The Congressional Budget Office estimates that the reforms in H.R. 5 could reduce medical liability premiums by 10 percent nationally and reduce the federal budget deficit by $45.5 billion over ten years.
I have also introduced legislation, H.R. 314, the “Medical Liability Procedural Reform Act of 2011,” that would authorize a limited number of grants to states to develop health care tribunals that would only hear disputes over injuries allegedly caused by health care providers. The judges would have specific health care expertise with the aid of independent expert witnesses commissioned by the court. In short, a doctor would be judged by his or her peer who understands all the aspects of providing care. This system would give both doctors and patients a fair and reliable way to settle disputes more efficiently while placing the focus back on patient safety and medical justice.
7) Strengthen Medicare for Current and Future Generations
- Medicare is a very important program upon which millions of Americans rely. Unfortunately, Medicare Part A expenditures have exceeded annual income since 2008, and the Medicare trust fund is estimated to be exhausted by 2024. Reform is challenging because of the rapid increases in medical costs, but action must be taken to preserve this program for current beneficiaries and to strengthen it for future generations.
I also believe that the current Sustainable Growth Rate (SGR) formula related to Medicare reimbursements to physicians must be eliminated and replaced with some measure that is connected to quality medical care. For several years I have supported legislation to do just that. Thankfully, Congress averted the 27.4 percent cut in 2012; however, yearly patches have created uncertainty for physicians and Medicare patients. We need to permanently fix this problem.
8) Simplify Medicare Forms to Help Prevent Waste, Fraud, and Abuse
- A contributor to high health care costs is the amount of money the health care industry spends on paperwork for Medicare and private insurance billing. There have been studies that show upwards of 31 percent of all the money we spend on health care in the U.S. is spent on paperwork and regulations. Talk to your doctor and hospital about how many people they must employ to fill out forms, and you will be amazed.
I have introduced H.R. 315, the “Health Care Paperwork Reduction and Fraud Prevention Act.” This bill seeks to bring Medicare and the medical community together with the goal of simplifying codes and billing practices to reduce waste and fraud within the system and improve efficiencies to limit unnecessary paperwork. This measure takes a practical approach by establishing pilot programs to work out the details with doctors, insurance companies, and government agencies before system-wide changes are implemented.
9) Block Grant Medicaid Payments to States with Increased Flexibility
- Medicaid is a jointly funded entitlement program to provide health insurance coverage to those with low-income, the elderly, and people with disabilities. However, the financing structure has continually pushed costs higher. According to the President’s fiscal year (FY) 2013 budget, total Medicaid net spending will amount to nearly $283 billion, an increase of 10.8 percent over FY2012 spending.
We should block grant Medicaid payments to states and give each state the ability to implement the Medicaid program in a way that works best for its citizens. Whether a state wants to allow Medicaid recipients to purchase a third-party insurance policy or create incentive programs to help bring down unnecessary costs, states should be given the flexibility to implement Medicaid according to the unique needs of their own populations. We should also protect the elderly in long-term care and the most vulnerable children who have fewer options available.
10) Expand Health Spending Accounts
Millions of Americans use Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) to pay for qualified medical expenses on a on a tax-advantaged basis. Qualified expenses include costs for which an insurance company will not reimburse such as deductibles, copayments, and non-covered services.
- Unlike the new health care law that placed new restrictions on these programs, we should expand their usage and allow individuals to take more control over their own health care spending. The House recently passed legislation to again allow over-the-counter medications to be purchased with health spending accounts that the new health care law took away. The bill also allows employees to cash out up to $500 of their remaining FSA balance at the end of the year and have it taxed as regular wages. Under current law, employees must forfeit any unused balance of their FSA back to their employer.