Repeal and Replace? I Don’t Think So!

 by    Dr. Alan M. Preston

An excerpt of this article appeared in the San Antonio Express News. It was written in regards to the Freedom Caucus going against the establishment in the “repeal and replace” of Obamacare. The Republicans recently passed a new and “slightly” improved version of the original legislation. I think this article still is salient to the new proposed legislation passed in the House. Here is the link ( Express News Article ) or simply feel free to read the article here in LN. ENJOY!

 The Republicans attempted to repeal and then replace Obamacare. Or did they? The proposed legislation was only 125 pages long and it did not “repeal” Obamacare. How do you replace something you did not repeal? So, what did the proposed 125 pages of legislation attempt to accomplish?

 The legislation put forth by Paul Ryan was an attempt to satisfy the Republican base that wanted to repeal the Affordable Care Act (ACA and i.e. Obamacare). The legislation did attempt to remove a few unpopular elements of Obamacare while retaining many of the elements of Obamacare that were popular. The Republicans currently claim they cannot “repeal” the ACA due to parliamentary procedures, yet they somehow sent a repeal bill of the ACA to President Obama in mid-January last year after the House made over 50 attempts of repealing it.  The Republicans are leaving their base with the impression that they really do not want to repeal Obamacare. They simply want to go through the motions of repeal for political expediency.

 The Democrats decided in block, not to vote for the “tweak” of the ACA. Yet the ACA is self-destructing. Insurance companies and doctors are leaving in droves, while the premiums continue to climb out of sight. Why would the Democrats not want the ACA improved? The simple answer is that any legislation that is proposed by the Republicans will be rejected by the Democrats. Yet the Democrats have “talking points” that claim are valid and what I attempt here is to go through the rhetoric under the light of truth and see it can stand the scrutiny of reality.

 After the Congressional Budget Office (CBO) scored the legislation to determine the effects of the new proposal, over 24 million individuals would decide not to be covered under Ryan-Care. The Democrats want those individuals covered. However, a closer look at those who will forgo coverage fall into three (3) basic groups:

1.     The largest group (approximately 20+ million) are those individuals that are receiving their health insurance for free because their state expanded the eligibility for Medicaid and they were covered under that expansion. Here is an analogy: If I gave you free Starbucks coffee every day, it is likely you would sign up for the free coffee, at least until it was no longer free. Once I took away the free program, you as an individual would decide not to purchase the coffee anymore. Just as it is projected, a large number of individuals will not purchase health insurance unless it is free. That group is, more than likely, individuals that are reasonably well and have determined that any illness they may incur is far off. And now that they may have to pay something for their health insurance, they do what most of us do; they exercise their individual right to make a decision as how to spend their money. Obviously the CBO projects that once this population has to actually pay for their health insurance, they will decide to use that money to buy something other than health insurance. That is indeed their right to make such an individual decision; however the many hate the idea so many people would be able to make such an individual choice, they would rather force them to purchase insurance via the "mandate".

2.     The second group, are individuals that were coerced to purchase health insurance via the individual mandate. Once the federal government removes the gun to the person’s head to make such a purchase, many will not purchase health insurance and use that money for other purchases such a buying a car or home. There is a lot the government can do when they have coerced a group to go along with the desires of the federal government. Many individuals do not like being forced through “mandates” to purchase anything and if you feel like you don’t need it at this time in your life, you will forgo the purchase. Nevertheless, the Democratic party opposes individual choices and prefer forcing people to make choices they deem appropriate. Thus the mandate in this instance and banning things in other instances. Have you purchased a 100 watt incandescent light bulb lately? Of course not...it is banned!

 Communistic and socialistic countries do not support the concept of individual freedom and choice, which we call individual liberty and freedom here in the USA. Thus, for those politicians who subscribe to a more totalitarian pathway, regardless whether on the Right of Left it seems natural to simply “mandate” individuals to do what the government feels is in your best interest. Those of you that support government interferenc, will hate this concept that individuals are allowed to make individual decisions; unless of course it is you that wants to make an individual decision... then somehow that is ok.

3.     The last group are those individuals that need health insurance; however, they make too much money to be eligible for Medicaid and make too little money to pay the high premiums for health insurance. For this small group, Congress contemplated granting to the states, 100+ billion dollars to create high risk pools to accommodate these individuals. Thus that small group will have financial relief in their respective state.

The Freedom Caucus is for individual freedoms and liberties. Forcing people to purchase something they don’t have a perceived need for or don’t want to purchase, is the antithesis of the founding principles of this great nation. Government coercing, is not a principle that the Freedom Caucus values for our citizens. Furthermore, Obamacare was mainly about catastrophic coverage for many. If you have to pay a monthly premium of $550.00 and then an annual deductible of $5,000.00, at the end of the year, you received no financial benefit for the first $11,500 of out of pocket expense. One could receive a lot of physician care for $1,000.00 per month. Thus, unless you had a catastrophic event, you received no benefit whatsoever having health insurance for the first $11,500.00. Or to put it another way, you were uninsured for the first $11,500.00 in coverage. I am not sure how anyone could suggest that Obamacare is affordable.

 The freedom Caucus of the Republican Party was getting a lot of blame for the first proposed legislation not passing in a blazing record of only 18 days. The brave members of this small but growing body probably saved the Republican Party from a tremendous amount of embarrassment by helping to stop proposed legislation that contained little to nothing towards lowering healthcare costs. This time around, we shall see what the Senate decides to do!

 The Freedom Caucus believes in the US Constitution and the philosophy of a limited federal government. When the federal government desires to dictate more and more of sections of our economy, then the tradeoff is that “we the people” lose parts of our individual liberties and freedoms. The Constitution never contemplated a federal government takeover of our healthcare services. 

 Those that disagree and claim that healthcare is a “right”, confuse the meaning of the word “right”. A right is not an entitlement. The 2nd amendment of the US Constitution protects citizens from the federal government and is enshrined in the “Bill of Rights”. Those RIGHTS cannot be taken away (by the federal government) from “we, the people”. The 2nd amendment does not suggest that if the federal government fails to finance your purchase of a handgun, that somehow you are denied your right to own a handgun. Likewise, if the federal government decides not to pay for your health insurance, that does not suggest your healthcare “rights” are somehow denied. Rights do not suggest a financial beneficial entitlement. This is a concept that is often lost on those that want more government rules and regulations and mandates and is difficult for them to comprehend in the least. Most of you will understand the point however. 

 Embracing our Constitution should not be seen as a Republican or Democratic idea; it is an AMERICAN idea. The members of the Freedom Caucus want legislation that embraces many of the philosophies that we have in our constitution. And as turns out, embracing constitutional principles has the added value of lowering healthcare costs for millions of Americans. They include concepts such as:

1.     Embracing the 10th amendment and allowing the states regulate local healthcare; not the federal government.

2.     Allow states to “experiment” with various market concepts to produce competition and better outcomes

3.     Let the market place develop products that are more affordable

a.     Reduce or eliminate the massive number of mandates that insurance companies now must comply with

b.     Allow for catastrophic plans to compete in the market

c.      Eliminate the Minimum Essential Health Benefit mandates that makes the cost of health insurance very expensive

d.     Relax the STARK laws so that doctors can collaborate more effectively toward integrated healthcare practices and quit assuming they will all engage in criminal activities.

e.     Continue to have private insurance companies compete for the Medicare, Medicaid and other federal insurance programs.

4.     Get out of the entitlement business and create special block grants for the Sates for those citizens that truly can demonstrate a financial need for healthcare services

5.     Reduce the restrictions placed on Health Savings Accounts (HSAs) so individuals can prepare for first dollar coverage when they select a high deductible plan. 

6.     Eliminate the idea of “federalizing” health insurance to cross state lines. This is a bogus argument in lowering healthcare costs due to the fact that insurance companies already operate in multiple states. I always shake my head in disbelief when I hear such nonsense that "allowing" insurance companies to sell across state lines will lower health insurance costs. United Healthcare operates in 50 states as an example. Federalizing insurance will not make United Healthcare wake up the next day and decide to lower their premiums. Who is so na?ve to believe this? This is simply a federal takeover move, disguised as a market-based solution; thus, bogus and deceptive and will not reduce premiums one penny.

Every time the federal government thinks they are the best at “fixing” the problems of our healthcare system, the cost go up and the choices go down.   Let’s focus on the real problem and find solutions for that segment that needs assistance and allow the remaining portion of the market to compete with one another. Blame the Freedom Caucus for the measure’s demise? Let’s be thankful it did not pass the first time and hope the Senate comes up with something better than simply tweaking the ACA.

Dr. Alan Preston is an experienced Chief Executive Officer with a demonstrated history of working in the hospital & health care industry. Skilled in both For-profit and Nonprofit Organizations, with tremendous background in managed care and Population Health Management Epidemiology, Instructional Design, Team Building, and Biotechnology. Strong entrepreneurship professional with a Doctor of Science (Sc.D.) focused in Public Health, Health Services Research from Tulane University School of Public Health and Tropical Medicine. Very involved in risk sharing contracts, ACOs, Medicare Advantage including RAP scores, HEDIS, and STAR ratings which helps physicians and health plans alike in reducing MLR!