Here’s What an Obamacare Replacement Bill Should Look Like

After last week, Republicans have a renewed sense of optimism about ending the disaster that is Obamacare. In pursuit of greater health care access, Americans have endured seemingly unending setbacks, from the U.S. Supreme Court upholding the law as a tax to insurers fleeing the marketplace.

Now, with Republicans leading both the presidential and legislative branches of government two months from now, the GOP must keep its promise to repeal and replace Obamacare with patient-centered reforms that will provide relief for the American people.

But, in a recent interview, President-elect Donald Trump explained that he would consider keeping certain parts of the law, despite ample evidence that it’s falling apart.

Since Trump has few, if any, ideological commitments to conservatism, this comes as no surprise to those of us who warned our fellow Republicans about him throughout the GOP primary process. But, it also means that he’s a blank canvas as it concerns policy, and Republicans have the opportunity to get to work.

There is no individual more poised to lead that effort than my former boss, House budget committee chairman Tom Price, M.D. (R-Ga.). Price, an orthopedic surgeon, developed his conservative alternative to Obamacare before President Obama’s signature law even passed. As former chairman of the conservative Republican Study Committee and a dedicated physician, Price combined his policy experience and his real-world expertise to develop the Empowering Patients First Act that contains a lot of inspiration for crafting a GOP replacement to Obamacare.

“Every day, we hear new stories of how Obamacare is harming patients. That’s why we’ve developed a plan to repeal Obamacare and start over with patient-centered solutions that adhere to the principles of affordability, accessibility, quality, innovation and choices,” Price told Opportunity Lives. “We are working to put patients, families and doctors in charges of medical decisions, not Washington, D.C.”

Here’s what an Obamacare repeal-and-replace plan should look like:

Yes, a full repeal is necessary. With compounding insurance costs for consumers and providers fleeing the market posthaste, it is simply impossible to begin implementing real health care reform with Obamacare still intact. So any efforts must begin with an immediate and complete repeal. The law is simply unworkable, especially with its funding schemes and counterproductive mandates, as the base for new reforms.

Republicans must have the political courage to withstand Democratic attacks on repeal, which they will inevitably frame as kicking millions of people onto the streets. The law remains incredibly unpopular, even as after years of its architects insisting it would become beloved to the American people as soon as they felt its benefits.

That hasn’t happened. In fact, Obamacare has endured overwhelming public disapproval since its inception, beyond partisan breakdowns. And with the recent news of premiums skyrocketing and fewer options available for patients, it’s probably even worse than polling averages would indicate.

But, Americans seem to agree that something needs to be done to address the rising costs of health care — costs that are bankrupting far too many Americans. That’s why legislation that includes a full repeal must also trigger a replacement package that meets some of these challenges.

If you want to achieve universal health care, you can do it by making it more accessible. You make it more accessible by making it more affordable.

So, as we approach replacing Obamacare, it’s important to recognize that Republicans and Democrats see health care goals much differently. Democrats have long desired universal coverage, while Republicans have always wanted greater competition to drive down prices.

The good news is that both parties can get what they want. If we make health care more affordable, it will become more accessible. If it becomes more accessible, more people can buy it.

But, in order to make it more affordable, there needs to be some serious reforms that would strip government of its overreach into the health care industry. Here are some reforms, both creative and proven, that would significantly drive down the costs of care:

• Medical malpractice reform: America is an incredibly litigious society. As a result, doctors must obtain costly medical malpractice insurance to shield them from frivolous lawsuits. Republicans understand that these costs are understandably passed on to patients in the form of more expensive care. In hopes of bringing down professional insurance costs for doctors, and in turn, for patients, some lawmakers support capping damages that can be awarded, which Democrats counter limits plaintiffs’ rights to a fair trial.

Price’s approach would allow each medical specialty’s professional society, such as the American Association of Anesthesiologists or the American Thoracic Society, to develop a set of best practices to determine how physicians should reasonably respond to various patient conditions. The set of standards could be admitted as evidence in court if a doctor is sued, so he or she can demonstrate that a proper diagnosis or treatment occurred based on recommendations from the corresponding specialty society. Currently, such a defense is inadmissible in court. With such a reform, the courts could more easily weed through frivolous legal actions, resulting in lower malpractice insurance costs for doctors and lower care costs for patients.

• Interstate purchase of insurance: If we can buy car insurance from another state, there’s no reason that we shouldn’t be able to buy health care. This is a concept that would be illogical to oppose, but state regulators are employed to keep a bureaucracy in place that wouldn’t allow for such competition. By loosening the regulatory stranglehold on insurance, we’d have greater choices from more places. More competition would mean lower costs and better quality coverage for families.

• Eliminating mandates: Mandates drive up costs. Get rid of them. A single man should not be forced to purchase coverage that includes maternity care. A Christian patient should not be coerced into buying insurance that features abortion provisions. Obamacare’s mandates have priced a lot of consumers out of the private marketplace, sending many people into substandard Medicaid or thrusting them onto plans they don’t like.

• Make it cheaper to become and remain a doctor: Most doctors leave medical school with hundreds of thousands of dollars in student loan debt. They should be allowed to perform public health service (rural clinics, public hospitals), at least part time, to discharge some of it.

Additionally, doctors waste too much time — time they could be using to see patients — dealing with regulatory compliance. Standardizing medical coding, permitting electronic medical records and telemedicine and allowing for the safe storage of unused prescriptions would significantly cut down costs incurred by physicians and passed to patients. House Committee on Ways and Means Chairman Kevin Brady (R-Texas) outlines such measures in his “50 Ideas to Improve Health Care.”

After costs are lowered, there are still those who would struggle to purchase insurance. But, there are plenty of ways to make quality coverage available to them.

Aside from those who are truly indigent, Medicaid is a totally unacceptable health care option. It artificially restricts access to quality care, creating true health inequality in America. It shouldn’t be the only choice people have.

There are many options for getting these folks covered, even those with serious pre-existing medical conditions. Here’s how:

• Tax incentives: All Republican replacement plans feature some semblance of tax benefits for health coverage. They vary from deductions, credits, refundable credits and advanceable refundable credits, depending on an individual or family’s financial situation. Instead of the direct subsidies of Obamacare, patients should be able to keep more of their own money to obtain the kind of health care they need.
• Enlarging the pools: Insurance risk pools are part of the actuarial science that group people together so that, in theory, there are more healthy patients than sick ones, allowing insurers to make a profit. The government controls “high risk pools” that provide coverage to those deemed “medically uninsurable.” These individuals were likely unable to receive coverage due to health concerns or pre-existing conditions.

Some Republicans support maintaining these “high risk pools” to cover these patients, especially minor children, with serious illnesses. But, this, of course, would require government mandates.

A better alternative is Price’s proposal in “Empowering Patients First” that would allow for pools to be freed of their current limitations and expanded to lower risk for insurance companies. In his plan, individuals and families seeking their own insurance can pool with others based on any association (a trade union, philanthropic organization or so on) they wish. Additionally, government bureaucrats could no longer restrict the size of risk pools, which could create pools large enough to absorb the risks associated with covering sick or chronically ill people.

How do we know those with pre-existing conditions would be covered in larger pools? We don’t. But, we have good evidence to assume they’d have a high likelihood of receiving coverage. After all, even someone with eight speeding tickets or three wrecks in a year could get car insurance. There would be serious market consequences for insurers who were known to restrict access to care for those who might pose a higher risk to cover.

Other Republican proposals would lower costs, safeguard the patient-doctor relationship, expand access to care and spur innovation. And all of this would be accomplished without turning over health care decisions to the government.

Check out the Opportunity Lives Solutions Studio to learn about just some of the conservative ideas to create a system of patient-centered health care.

Ellen Carmichael is a senior writer for Opportunity Lives. Follow her on Twitter @ellencarmichael.