NRO: A New Republican Health Plan

Source (PDF):

Some things to like. Some things not to like.

My preference would be to eliminate any illusion that insurance is a viable financial model for health care funding (it isn’t). The plan moves slightly in that direction with its handling of health savings accounts; specifically, by allowing employees to receive employer-paid premiums as cash payments into an HSA.

In any case, those who’ve been criticizing the president and the GOP for not putting a reform proposal forward have now lost a talking point.

31 thoughts on “NRO: A New Republican Health Plan

  1. Your position on insurance is well documented.

    Funny how it took the GOP over 10 years to come up with a replacement plan. And like you said, some to like, some not so much. Which means it could be possible, as not everyone gets what they want. You know that dirty little word: compromise.

    HSA’s have been a part of things for many years. It was available as a benefit at BAE when I worked there. It is a benefit for YMCA employees today. I do think this new plan does make HSA’s more attractive as an option for self insurance if that part of it can get through.

    However, I also so this as similar to the GND: An outline to get to a better outcome. Whether it would or not remains to be seen. It will also be interesting to see what the CBO and others who usually put their analysis two cents worth in on it.


    1. Current limit on HSA contributions is, what, $7K? Okay, so you start at age 24 and plop down the max every year, never use it, invest it at 7% and then try to pay for 4 rounds of chemo at $35K/shot in today’s dollars 20 years from now.

      Good luck.

      The Republicans killed the BEST medical plan that they ever concocted when the prosecuted Kevorkian.

      Liked by 1 person

      1. RE: “Current limit on HSA contributions is, what, $7K?”

        The proposal would increase that to $18,0000 and expand options to allow HSA to be used for medical expenses instead of insurance. This would allow HSA owners to “self-insure,” which is how health care financing should work.


        1. John,

          HSA can ALREADY be used for medical expenses including dental or eyeglasses, etc. They can be used for any IRS Pub 502 expense. How’s that jock itch? Use HSA money for your Tinactin.

          $18,000? Okay, so where will a couple of kids making $60K/yr get that? Oh yeah, and another for their 401(k). That’s $36,000/yr. Sleeping in my car was fun in college.

          Self-insure? You mean “purchase their own insurance”, right?

          Because until Obamacare, most policies came with a $1M lifetime payout, and that wasn’t enough for a lot of people. That was the 3rd prong of the pitchfork that Americans were skewered on — preexisting conditions, declined coverage, and lifetime payouts.

          Against drug costs of, oh say, $10K/month, how comfortable do you feel with your current IRA paying for your medical expenses?

          Sounds to me like the GOP plan is selling you what you already have and that you don’t know enough about medical costs and insurance to know the difference.

          Liked by 2 people

        2. RE: “Sounds to me like the GOP plan is selling you what you already have and that you don’t know enough about medical costs and insurance to know the difference.”

          Instead of guessing and making assumptions and accusations, why don’t you read the proposal? The HSA discussion begins on page 41. There, for example, you’ll find the following statement:

          “Under current law, health savings accounts plans cannot be used in conjunction with plans that are
          not a ‘qualified high-deductible health plan.’ This unnecessarily hamstrings the ability for millions of Americans to access this important savings tool. Accordingly, the RSC would eliminate this requirement to allow health savings accounts to be utilized even if a person does not have a health insurance plan.”

          Also, as I use the term, self-insurance means using one’s own money to pay for medical expenses, not using a health insurance policy. Self-insurance becomes feasible for even poor folks when they can elect to receive cash in the amount of a premium payment instead of insurance coverage from an employer.


      2. @Naive

        To effectively (at some reasonable level) “self-insure” is simply beyond the reach of 90% of the American public.

        The “I got mine” crowd will protect themselves at the expense of those less fortunate to their dying breath.

        The best thing about “old white men” is that they will die sooner rather than later; the bad news is they will continue to do damage to our Republic in the process.

        Liked by 2 people

        1. I’ll give you a hint, this is for John’s benefit.

          I’m in the top 5% based on total household assets. That’s just a fact.

          I quit working at 60 and in the years before turning 65, I could have self-insured. By that, I mean I could have gone with a “self-coverage” policy offered by an insurer.

          Basically, I accept, say, Aetna’s coverage and negotiations with providers, offer them proof of my assets (back accounts, etc., etc.,), they process the claim, and then I stroke the checks to cover the claim. That way a hospital won’t look at me funny because I don’t have an insurance card and I won’t have to go through the “proof of means” every time I see a provider, or have to carry a blank check made out to Sentara in my wallet.

          [BTW, John, that’s what “self-insured” means as opposed to “uninsured”, and it still costs on the order of a couple of $100/month just for the claims processing and the ID card]

          I chose to pay $18K/year for a $12K deductible family policy because I am in the top 5% and I know that one automobile accident, and I would have been in the top 20% within a week.

          Liked by 2 people

    2. RE: “Funny how it took the GOP over 10 years to come up with a replacement plan.”

      ACA became law seven years ago, and the administration that sponsored it didn’t leave office until three years ago, so it’s hard to see what’s “funny,” or what the point of your aspersion might be.


      1. The ACA was signed into law by President Obama on March 23, 2010.
        So my math is bad. But yours is just as bad.

        Semantics again. Repeal “Funny”, replace with “Interesting”. That is how you repeal and replace!

        The GOP ran in 2010 on repealing and replacing the ACA without a plan to replace. They talked and talked and talked about it up until 2018 when they tried running, again, on repeal and replace and the analysis has shown that issue was one of the major reasons they did not hold the House


      2. RE: “But yours is just as bad.”

        I stand corrected. Your comment still, however, distorts the truth. The fact the GOP was unsuccessful doesn’t mean they did nothing or deserve the characteriztion you give them.


        1. RE: “What was their plan?”

          There were a number of them, including one, the American Health Care Act of 2017, which passed the House and was voted down in the Senate.


    1. RE: “ACA being a conservative based plan first endorsed by the Heritage Foundation”

      It wasn’t. You are confusing the ACA as a whole with the individual mandate proposal, which the Heritage Foundation ultimately rejected as unconstitutional. In any case, the meme you are repeating is false.


      1. Just because Heritage decided the plan was unconstitutional does not mean the plan was bad, or even necessarily unconstitutional.

        The key was the mandate. Political pressure kept it too low to be effective. And without the mandate, as Trump has done to it, universal health insurance with more young and healthy than older and less healthy won’t work as well.

        BTW, ACA was signed into law March, 2010, close to ten years ago. The GOP had more than enough time to draw up an alternative even if ACA wasn’t enacted for a couple of years. The fact is they never did anything until Trump was elected and then they cobbled together a mess behind closed doors which McCain killed. Essentially Republicans have had more than enough time and resources for a decade. And had they actual put together a workable plan it might well have passed the Senate.

        Liked by 1 person

          1. …”I agree with my legal colleagues at Heritage that today’s version of a mandate exceeds the constitutional powers granted to the federal government.”

            Like I said, “attempted backside covering. “TODAY’S” Yerp.

            Liked by 1 person

          2. “ First, it was not primarily intended to push people to obtain protection for their own good, but to protect others. Like auto damage liability insurance required in most states, our requirement focused on “catastrophic” costs — so hospitals and taxpayers would not have to foot the bill for the expensive illness or accident of someone who did not buy insurance.

            Second, we sought to induce people to buy coverage primarily through the carrot of a generous health credit or voucher, financed in part by a fundamental reform of the tax treatment of health coverage, rather than by a stick.

            And third, in the legislation we helped craft that ultimately became a preferred alternative to ClintonCare, the “mandate” was actually the loss of certain tax breaks for those not choosing to buy coverage, not a legal requirement.”

            Semantics and juggling.

            Requiring insurance with ACA was to insure that everyone signed on so there would be no freeloaders and keep rates reasonable. And, very importantly, it allowed the provision of no pre-existing conditions because the insurance companies knew that they would get a good pool of young and healthy premiums payers

            “Loss of tax breaks” means sending more money to the government. A fine or tax for not buying health insurance means (drum roll please) sending more money to the government. Just like the effects of number two with “tax treatment” and “vouchers” where if you participate you get a rebate and if you don’t, effectively more money to the government.

            Mr. Butler at Heritage is redefining chocolate milk as chocolate with a lot of milk instead of milk with a little chocolate.

            It’s still chocolate milk.

            Just because the Democrats used their ideas, the conservative intelligentsia is now reshuffling the deck and issuing at lot of “but, but…it’s, uh, umm, not the same”.

            The BS meter has pegged again.


            Liked by 2 people

          3. RE: “Attempted backside covering.”

            Call it whatever you want. The fact remains nothing about the ACA was ever based on a Heritage Foundation plan. You should avoid repeating the falsehood.


      2. The Heritage Foundation, which did include the Individual Mandate in the 80’s, amazingly decided, AFTER the passage of the ACA that the mandate was unconstitutional. It appears to me that the HF only backs it’s own ideas when presented by a Republican. If it had been President McCain in 2009 who pushed McCaincare through, the HF would have been popping champagne corks.


    1. The problem with TLP, ACA and GOP is they they are all just focused on insurance, not the broad spectrum of healthcare. Insurance just reflects the costs it has to pay for. Competition in that market might drive down some rates as ACA does where several insurers offer plans in a state or region.

      But here is the new wrinkle since the TLP plan proposal. Regional medical facilities like Sentara are not only monopolizing hospitals and clinics, they are also bringing in physicians, particularly the best ones in many fields. So if Humana wants access to Sentara’s own network, they have to pay Sentara’s prices. No longer are insurance companies holding the whip hand by saying we have a half million customers and if you want them, you will lower your rates for us.

      That does, or will if the trend continues, neutralize the idea of patients going to groups like ADA to get a better deal.

      Which brings us back to the core issue: prices for providers, drugs, devices, tort insurance and emphasis for much healthier lifestyles.

      Liked by 1 person

      1. “The problem with TLP, ACA and GOP is they they are all just focused on insurance,…”

        The problem is that the private provider, private payer system depends on honest brokers. There ain’t any.

        The Purdue family comes to mind. They reaped $400B and face $50B in a settlement. If it took the government 30 years to catch these rats, you know damned well that the insurance companies were complicit for 20 of those years.

        Show me the way to make Oxycontin.

        Liked by 1 person

      1. No, the devil is in the socialism.

        How about we refer to an expert on socialism. Boris Yeltsin, on how the free market compares to socialism.

        There is no reason a truly free market cannot do for health care what it does for groceries.

        In almost every part of our lives the free market does every day what government cannot do on its best day.


        1. As a huge proponent of the Free Market system I’d agree with Boris, but certain aspects of Socialism are needed for the common good.

          As much as “purists” might want them to, needful benefits don’t just “trickle” down…

          Liked by 2 people

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