A Health Plan For President Trump
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The Heritage “Trump” healthcare proposal aims to transform the current system by delinking health care from employment, allowing individuals to own portable insurance.
This is Heritage’s health care proposal you asked about. It’s not a comprehensive plan but offers a series of potential, in many cases current innovations based on the current system (some of these, like telemedicine, likely have been accelerated by the pandemic)
Steve
- Provide opportunity for individuals to delink health care from employment. “…In an ideal world, most people would own their own health insurance and take it with them as they traveled from job to job and in and out of the labor market. Some employers may have better insurance than is available on the open market. But others might prefer to make a cash contribution to help employees pay their own premiums rather than provide insurance directly. Some employers were actually doing that before Obamacare. They used an account called aHealth Reimbursement Arrangement (HRA), providing tax-free funds employees could use to buy their own health insurance. But with Obamacare came regulations and threats of steep employer fines that effectively deep-sixed this option. Thankfully, the Trump administration is reversing course. Beginning next January, employers will be able to use HRAs to help employees obtain their own coverage with the administration’s blessing…”
- Make Medicare more open to “direct primary care.”“….Under the arrangement, Medicare would pay a fixed monthly fee to a physician or physician group instead of the traditional fee-for-service payments. In return, the physicians would provide virtually all primary care. The fees would range from $90 to $120 a month, depending on the patient’s age and medical complexity….”
- Expanded use of telemedicine“…Medicare doesn’t pay for any of this. And since private insurers and employers tend to pay the way Medicare pays, the entire country is missing out on incredible advances in telemedical technology….Federal law (the Social Security Act) allows Medicare to pay for telemedicine only under strictly limited circumstances… The CMS is acting aggressively to change this. As of January 1 of this year, doctors in Medicare Advantage plans and accountable-care organizations can now bill Medicare if they use phone, email, Skype, and other technologies to consult with patients remotely to determine if they need an in-office visit. Patients can be anywhere, including their own homes. Doctors can also bill Medicare to review and analyze medical images patients send them. And they can bill for telemedical consultations with other doctors. But these are still baby steps. Congress needs to liberate telemedicine once and for all….”
- Allow specialized healthcare plans“….The most successful Obamacare insurers are Medicaid contractors. The plans that have survived in the exchanges look like Medicaid managed care with a high deductible. The networks include only those doctors who will accept Medicaid fees coupled with all the hassle of managed-care bureaucracy….Before Obamacare, most states had risk pools for the small number of people who entered the individual market with an expensive preexisting condition and were denied access to ordinary insurance coverage. The risk-pool plans looked like garden-variety Blue Cross plans, with access to almost all doctors and hospitals. While some risk pools had problems — such as being over-subscribed and unable to take new customers — those problems were discrete and addressable…..Health Care Choices Proposal, developed by the Health Policy Consensus Group and supported by more than 100 conservative leaders across the country. This proposal would block-grant Obamacare funds to the states and give them wide discretion to reform their individual health-insurance markets. The Center for Health and the Economy estimates that this proposal would lower health-care premiums by as much as a third, would insure about the same number of people as Obamacare, and would better protect people with preexisting conditions and high health costs….”
- Expand use of Health Savings Accounts, “…To take advantage of the full potential of HSAs, we need three policy changes: (1) People should be able to use completely flexible HSAs, wrapping them around any health-insurance plan and using them to pay for any medical costs the plan does cover; (2) they should be able to use their HSAs to pay premiums as well as out-of-pocket expenses; and (3) health plans should be allowed to have “shared savings programs,” where enrollees who choose better and cheaper care get to keep their share of their savings in their HSA…”
Marie Fishpaw and John Goodman, "A Health Plan For President Trump," Heritage Foundation, August 2, 2019, https://www.heritage.org/health-care-reform/commentary/health-plan-president-trump - Make Medicare more open to “direct primary care.”“….Under the arrangement, Medicare would pay a fixed monthly fee to a physician or physician group instead of the traditional fee-for-service payments. In return, the physicians would provide virtually all primary care. The fees would range from $90 to $120 a month, depending on the patient’s age and medical complexity….”
Ed Comment:The numbers in this article don't seem to add up. It says 30 mm are uninsured. Then it details 10 million and seems to call it 2/3s. Then it has a category zero million.
Ed Comment:Hard to see that 100mm people are at risk of losing coverage and/or can't get HC. 20 mm are subsidized and don't take it. 2.6 can afford it and don't take it. Half of the remainder are illegals. Many people won't be very sympathetic to them and we still give them some/essential HC so it looks like 3 of the 30 might want it but can't get it. The rest are all covered. That said, I still don't know how many people with pre existing conditions significant enough to truly prevent them from being covered are being "saved" by obamacare. (The ones with employer coverage would get it). So it looks like the true number is at risk is much smaller than 100mm Can you please take all your entries and sort everyone into buckets including the elderly. One bucket would be resting conditions covered by employers. It would be great to see those who were eligible for Medicaid and chips without Obama care and those who were added to it because of Obama care. A clear top down picture would be useful/enlightening.
Jim Capretta Comment:"Thank you for pointing this out (not sure why no one else did). Some numbers got lopped off in the translation from what I submitted to what got posted. Here are the correct numbers in order of the first bulleted points: 5.1 million people 5.5 million 9.4 million Then in the next bullets it should be: 4.0 million 2.6 million I hope this is clear enough.”
Ed you were right, 30mm persons < 65are currently uninsured, but I can’t line his numbers with the reports, according to theCBO(See Figure 1, 67% of uninsured persons are currently eligible for subsidized coverage) Before I sent you a note that it was wrong I wanted to confirm with him, he said it was a typo on AEI’s part.
Capretta, "...In 2019, 12 percent of the nonelderly population — or about 30 million people — went without health insurance..."
Kevin McNellis, Carolyn Ugolino and Emily Vreeland, “Federal Subsidies for Health Insurance Coverage For People Under 65: 2020 to 2030,” Congressional Budget Office, September 2020, https://www.cbo.gov/publication/56650
Steve Comment:I’m still working on thenumber of individuals with pre-existing conditions who currently get coverage through employment and the number who are buying it on the exchanges due to the ACA. This is proving a little hard.But I wanted to show you a topdown snapshot of the <65 population,90% are covered if you exclude illegal immigrants. (According to theKaiser Family Foundationanother67.7mm >65 individuals are enrolled in Medicare in 2020.)According to CBO 155mm (57%) of the 272mm individuals < 65are covered by employment based coverage this year. But in terms of the number of people < 65 “saved” by Obamacare in 2020 CBO estimates13mm(so 5% of <65) individualswere added to Medicaid due to the ACA.See table A-1. In total70mm (28%)individuals <65 are covered by Medicaid. Note one thing from footnotes as this caught me up “The components do not sum to the total population because some people report multiple sources of coverage. CBO and JCT estimate that in every year of the projection period, between 12 million and 14 million people (about 5 percent of the insured population) have multiple sources of coverage, such as employment-based coverage and Medicaid”
Ed Comment:Hard to see that 100mm people are at risk of losing coverage and/or can't get HC. 20 mm are subsidized and don't take it. 2.6 can afford it and don't take it. Half of the remainder are illegals. Many people won't be very sympathetic to them and we still give them some/essential HC so it looks like 3 of the 30 might want it but can't get it. The rest are all covered. That said, I still don't know how many people with pre existing conditions significant enough to truly prevent them from being covered are being "saved" by obamacare. (The ones with employer coverage would get it). So it looks like the true number is at risk is much smaller than 100mm Can you please take all your entries and sort everyone into buckets including the elderly. One bucket would be resting conditions covered by employers. It would be great to see those who were eligible for Medicaid and chips without Obama care and those who were added to it because of Obama care. A clear top down picture would be useful/enlightening.