Polls show that healthcare is high on the list of voter concerns. Right now, that’s bad news for Republicans.
Democrats are running ads accusing Republicans of cutting Biden-era subsidies for prescription drugs for the elderly and disabled on Medicare and cutting Biden-era subsidies for people who buy their own health insurance coverage. Fortunately, there is a powerful Republican response. It consists of four Trump administration ideas. Unfortunately, the administration has done little to explain the ideas, and most Republican candidates are ignoring the subject altogether.
President Donald Trump’s most important proposal is to let people who buy their own health insurance choose plans tailored to their needs. Yet the White House post that advances this idea gives us none of the details that candidates and voters are going to need to understand it. KFF says most families could cut their premiums in half by buying the kind of insurance that used to be commonplace. If they do that, how much help should they get from the government?
Well, if they choose coverage that is less comprehensive than exchange plans are required to be, a reasonable subsidy might be equal to, say, 75% or 80% of the subsidy they would have received if they had enrolled in an exchange plan. Families would gain because the premiums are lower, and taxpayers would gain because the subsidies are smaller.
What about the Democrats’ charge that people will choose “junk insurance”? People might fail to insure for a problem they didn’t anticipate — alcohol or drug abuse, for example — only to later discover that they made a mistake. This is the kind of benefit the (Obamacare) exchange plans are required to cover. The answer: If such a problem arises, people should immediately be able to switch to a benchmark silver plan in an exchange. Obamacare exchange insurance doesn’t go away. For the rare cases where it might be needed, the exchange would be there as backup insurance.
Trump’s second-best idea is to give government subsidies to people instead of to insurance companies. Again, we need details that are not there so far.
But here is a suggestion: Health plans should be free to offer their enrollees a deposit into a Health Savings Account in return for their willingness to manage an area of care themselves, such as preventive care, primary care, chronic care management, etc. The model for this is the highly successful Medicaid Cash and Counseling program. It sees the homebound disabled given a budget to manage, including the right to hire and fire the people delivering services to them.
Consistent with Trump’s previous policy initiatives, people should have the option to use their HSA funds to make monthly payments to direct primary care doctors who provide 24/7 primary care, including communication at night and on weekends. At Atlas MD in Wichita, Kansas, which pioneered the model for this practice, the monthly fee for all primary care is $50 for a mother and $10 for a child. This approach is exponentially better than the current system, under which the average deductible for a silver plan is $5,304. For people who are admitted to a hospital or who need expensive drugs, the current out-of-pocket exposure is $10,600 for an individual and double that for a family, according to healthcare.gov. Next year, the potential exposure will jump to $12,000 and twice that for a family.
A third Trump idea is incorporated in an administration rule that has been largely ignored by the legacy media.
One of the worst features of the marketplace exchange plans is their narrow networks, which often exclude some of the best doctors and the best medical centers. The new rule will allow non-network plans, which pay fixed prices for various procedures and allow enrollees to see any provider. The resulting price competition has been shown to save significant amounts of money.
A fourth idea would give patients access to cheaper drugs.
Although the administration often talks about a “most favored nation” approach, a more appealing initiative is TrumpRX, one of the most impactful things Trump has done on healthcare. This website shows the “cash price” of drugs, which are often one-half, one-third, or even one-fourth of the list price. Patients can buy at these prices on sites such as Mark Cuban’s Cost Plus Drugs. But they cannot be purchased by employer plans or by commercial health insurance.
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The Republican message should be: let everyone have access to the cash price. Congressional legislation could make this happen.
Instead of pouring more money into failing, highly defective programs (the Democrats’ approach), the Trump approach would empower patients, free the marketplace, and encourage price and quality competition. But first, the Republicans have to start talking about it.
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[ H/T Washington Examiner ]
