Recent Health Care Reform Successes: Taking the Next Steps

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The Left insists that any health reform proposal that doesn’t embrace big government solutions will leave many Americans with no healthcare at all and abandon those with pre-existing conditions. Yet giving government control over decisions that rightly belong to patients and doctors has a known record of failure.

One need look no further than Obamacare. According to its supporters, it assures health care for people entering the individual market with pre-existing conditions. Yet individuals who leave employer plans find three unpleasant surprises when shopping for coverage in the Obamacare exchanges: higher premiums, higher out-of-pocket costs and more limited access to care.

In too many cases, the practical result is no coverage at all. This is even true of patients with pre-existing conditions, who became worse off under Obamacare, contrary to the Left’s preferred narrative.

Yet in the two national debates so far this year, there has not been any discussion of why Obamacare’s failed attempt at government-run health care somehow justifies more government control of health care. Nor has there been any discussion of recent successes in health care reform.

Over the last three years, the administration has implemented many reforms within the framework set forth in its policy roadmap, “Reforming America’s Healthcare System Through Choice and Competition,“ reforms that should serve as a guidepost for any administration. Here are just some of the recent successes in federal health care policy, and some “next steps” future administrations should adopt:

Better care and protections for the sick. Obamacare’s mandates encouraged plans to attract the healthy and avoid the sick by narrowing provider networks. Other laws made it hard for consumers to use health savings accounts and for insurers to offer plans that specialize in chronic illnesses.

If you’re in Medicare Advantage and have a chronic illness, private insurers can offer specialized plans that respond to your needs. And, the current administration has expanded the ability of these plans to offer targeted benefits.

Thanks to federal waivers, seven states have reformed their individual markets, setting aside funds for the care of the sickest, most costly enrollees, without forcing the healthy to pay exorbitant premiums. In states embracing these reforms, premiums fell by nearly 7.5 percent, on average, even as they rose more than 3 percent elsewhere. In Maryland, premiums that had been expected to rise 30 percent fell by 13 percent thanks to state reforms.

Next Steps: The chronically ill should have access to centers of excellence that specialize in their care. And Congress should build on the waiver successes by converting Obamacare’s subsidies to formula grants and giving states wide discretion to implement insurance markets reforms that will lower premiums and deductibles, and broaden provider networks

Continuity in coverage and doctors. More and more people are changing jobs regularly, which makes it important that workers control their coverage, even when their employers fund that coverage. This is especially true during the current coronavirus challenges. The administration has made advances in this direction, making it easier for employers to fund their workers’ insurance like they do a 401K – i.e., giving them cash to buy coverage they pick for themselves and can take with them when they leave.

Next Steps: Congress should complete the job by letting workers use their employer subsidy – and the low-income who get government subsidies - to buy whatever plan they want, rather than be restricted to plans designed by government. Lawmakers should also make it easier for people to choose their primary care doctor directly.

Knowing the price before you buy. Taking on the medical industrial complex, the administration insisted they give patients access to prices before they get care, so they can do comparison shopping. It’s also a first step toward ensuring you never face a surprise medical bill. The administration has also pushed for giving people more choices in insurance coverage—additional plans offering a greater variety of coverage options.

Next Steps: Lawmakers should make these options permanent, and allow consumers to choose lower-cost care.

Next Stop: Congress. The administration has followed its health reform roadmap and logged many successes along the way. But it’s gone about as far as it can under current law.

It has deregulated insurance markets and liberated innovators. It has allowed states to mend broken private markets, and empowered patients to seek better care at lower costs. Congress needs to complete the job by clearing away the remaining government barriers that block Americans from getting the affordable, high-quality health care they deserve.

Marie Fishpaw is the director of domestic policy at The Heritage Foundation. John Goodman, PhD, is the best-selling author of “Patient Power” and “Priceless: Curing the Health Care Crisis.”

 

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