The “CARE” Act, standing for patient Choice, Affordability, Responsibility and Empowerment, is the new Republican proposal to repeal and replace Obamacare.
Two House committees will shortly consider it. Unfortunately, it amounts to a new entitlement program on top of the existing Obamacare insurance regulations — not in lieu of them.
In theory, it focuses on the health care consumer taking personal responsibility, but it continues to pick “winners” and “losers” among different classes of consumers, and continues to protect insurers and Big Pharma from essential measures to keep “gross” health care costs down.
In fact, most of the cost-curbing measures and consumer protections of Obamacare are repealed. The elderly (those on Medicare) and those with significant chronic illnesses will be the “losers,” and here are some of the reasons why:
- There is now a 1-5 ratio for health insurance premiums. Under Obamacare, it’s a 1-3 ratio of health insurance premiums based on age. As in, insurers can charge older Americans up to five times what younger Americans pay instead of three. This will be costly to the elderly.
- It reinstates preexisting conditions except for those who maintain continuous coverage.
- There are no lifetime limits. However, annual limits are reinstated, so if you have high costs for any given year, there will be a ceiling on coverage.
- Children can temporarily stay on their parent’s plan until 26 during the transition, but states can opt out. After the transition, children will not be able to stay on their parent’s plan.
- You CAN now be charged more based on gender or if you were sick in the past.
- Medicaid is altered dramatically — expansion is eliminated and will probably leave tens of millions of adults without coverage options. We will go back to the old way of narrow eligibility if a state chooses. This doesn’t go well with the automatic enrollment of plans either. An individual adult with a low income could be automatically enrolled in a plan they couldn’t afford and thus lose their right to renew coverage. But their income could exclude them from Medicaid. Since the under 26 rule is being phased out, we could be talking about a 19-year-old trying to find health insurance themselves if they realize they need it.
Medicare and Medicaid are fiscally insolvent — nothing in the CARE Act lowers the costs of medical goods and services in those or any insurance programs. Premiums will go up on the elderly. Medicaid will return to the states in a restricted form. As the costs of goods and services are not lowered, fewer people will get care and likely suffer for it.
Regrettably, this GOP plan repeals only the taxes, subsidies, and Medicaid expansion, but will retain the Obamacare insurance coverage regulations that are responsible for making insurance actuarially insolvent and depressing the job market.
Truly free markets are needed in health care. The key to keeping federal spending down is to lower actual unsubsidized costs of care for all Americans. And in doing so, we must require true price transparency and neutrality.
Why not post the price for each procedure and service, plus the best information on its utility? Let’s restore price competition to the health care sector so consumers can make informed decisions.
We also need to stop subsidizing other countries’ health care systems by overpaying for drug prices — and nothing in this bill touches this.
Drug companies should not be permitted to charge a higher price to privately insured Americans (or to Medicare and Medicaid) than the lowest price charged to any of the 35 member “developed” countries in the OECD (Organization for Economic Cooperation and Development).
I continue to advocate that pharmaceutical companies should be held accountable through anti-trust laws already on the books — they should be fined and, if need be, criminally prosecuted if those companies continue to price-gouge consumers. It’s not as extreme as it sounds. Use 15 U.S. Code (the Sherman, Clayton, and Robinson-Patman antitrust acts).
We should all wait to see the CBO analysis of this bill. I suspect the Congressional Republicans with try to push this through without CBO scoring.
In the meantime, it’s telling who hasn’t complained about the CARE Act to date. Neither Big Pharma nor the insurance industry has raised any criticism and I suspect they were instrumental behind the scenes over the last three months, as their interests seem protected.
Unless Republicans attack the anti-competitive and monopolistic practices that are keeping gross health care costs up — for everything from drugs to simple procedures — the health care system will continue to serve special interests and not the American people.
The CARE Act is an inauspicious start. Hopefully President Donald Trump will see the devil in the details (the lack of true price transparency and competition and unaddressed drug prices) and insist the bill be changed.
Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, is CEO of Foxhall Cardiology PC and a regular contributor to LifeZette.