• A few points about Romney’s “repeal and replace”

    Sarah Kliff helpfully interprets Mitt Romney’s Meet the Press statements about health reform as meaning he is in favor of preventing individuals with pre-existing conditions from being turned down from a plan if they have continuous coverage. That is, if you remain enrolled in some insurance plan, you can switch from plan-to-plan without any barriers due to pre-existing conditions.

    Kliff then points to the 1996 Health Insurance Portability and Accountability Act (HIPAA), which already provides such protections. Families USA has a nice summary that explains how HIPAA works in the group and non-group markets. In light of this, it is not clear to me what new Romney is offering in terms of portability.

    Of course neither HIPPA nor Romney’s portability concept(s) address circumstances in which individuals do not have continuous coverage. That is, they don’t by themselves help the uninsured. Additionally, just because one has access to a plan, doesn’t mean one can find one that is affordable. I know Romney  has some ideas that he believes will reduce the cost of insurance (see his vision here). It’s not clear to me that they are intended to match the level of subsidization to low-income families that the Affordable Care Act (ACA) offers. In fact, I think that’s probably the point. That’s one reason why the proposal is likely less costly for the federal government.

    Next, Romney wants to level the playing field with respect to the tax treatment of health insurance. I’ve addressed that point already, explaining how current law will roughly and gradually achieve just that (the Cadillac tax).

    Now, neither the Cadillac tax nor HIPAA is ideal. And my point is not that they are necessarily preferable to whatever Romney is offering (though details on his vision are insufficient for a full comparison). My point is only that there are elements of his vision that are already in some way addressed in current law. To some extent, they deviate from better ideas due to political forces that would also buffet Romney’s proposals. That’s political reality.

    Finally, striving for universal coverage does not appear to be a priority of the Romney plan. If it is, I haven’t seen how it will work. Of course, Romney once had a pretty good idea in this regard. Once again, it seems like a lot of his vision(s) has (have) already made it into law (portability, tax equivalence, insuring the uninsured). He’s actually fairly good at health policy. He really ought to take more credit for that. I, for one, applaud him. Now, I’d like to see him put his effort into fleshing out some of his more novel ideas.


    • I’ve had quotes for insurance above the “Cadillac” plan cut off. Believe me, they weren’t for Cadillac insurance. They were for Chevy benefits for people living overseas and without exclusions for pre-existing conditions.
      It would be infuriating beyond belief to pay a luxury tax because you can’t get a decent price on your insurance.

    • Dr. Frankt: Out of curiousity, at what level of income do you believe a person should make before being ineligible for Federal subsidies?

      • Not Dr. Frankt here (and I don’t speak for him) but I think you need to realize that everyone gets Federal subsidies for some part of their health care expenses. For instance, in another post on this site today it stated that the Federal subsidy in the form of tax exemption for health insurance costs $250 billion a year (about half the Medicare budget). Everyone gets this subsidy regardless of income but high income people benefit more.)

        • “Everyone gets this subsidy regardless of income but high income people benefit more.”

          Yes, everyone who gets insurance through an employer gets the subsidey and benefits; but the second claim is not true in general. Although higher income people may pay a larger marginal tax rate. proportionately, lower income people benefit MUCH more from the tax deductibility of employer-paid health insurance.

          • You can play the proportional vs absolute game both ways, can’t you? But to the government, a dollar is a dollar. It’s effectively handing more of them to wealthier people. What’s the policy rationale? What’s the economics rationale? Don’t lower income people have higher marginal utility of income?

    • And it is these subsidies, like the many others offered by the Feds that are adding to the nation’s crippling debt problem. Go ahead, raise taxes on the wealthy if you’re a Democrat and keep them lowered if you’re a Republican. Just don’t expect much of an outcome either way. Unless you fix the cracks in the wall, the house will still tumble down.

      Although there is much to the ACA I like, there are a few things I do not. This includes, in part, the Exchange subsidies. According to a 2011 Kaiser Family Foundation report, 2011 family health insurance cost $15,073 of which $4,129 was paid by the employee. I could not determine for what size of family these averages were for, but for the sake of this argument, let’s assume it is for a family of four. The health insurance exchanges offer subsidies of varying amount for individuals up to 400% of the Federal Poverty Level. This means that in 2012, a family of four could make up to $92,000 per year and still recieve government aid. in 2013, this number will rise. Assuming that this family of four recieved zero aid and paid the full price out-of-pocket, they would still be left with $77,127. I understand that these individuals are more likely going to have employer-based coverage and will not recieve subsidies anyway, but at what point do we say enough is enough? $92, 000 may not be much in DC but in certain parts of the country, you’d be considerably well off. Last October I attended an Exchange conference and put this question to DC-based think tank analysts. They, too, agree that 400% is rather high.

    • You may be aware that the 2012 Republican Platform explicitly addresses the question of pre-existing conditions. Specifically (and astonishingly), the RNC Platform calls for allowing insurers once again to deny coverage for pre-existing conditions, unless the applicant had had “continuous coverage.” So — LOTSA LUCK to new applicants.

      Does Romney support the official position of his party, calamitous as that position is?

    • @Curtis Miles

      !5K$ is an obscene sum. You should look at international policies. Mine, for a family of 4 is 7K$. That’s for an American family living abroad. The price would drop to 4.5K$ if I were to go for worldwide coverage excluding the US. In short, treatment at any of the best hospitals in the world, except the US is a quarter of the cost of guaranteeing bills at East Podunk Community Hospital.

      You can Google these numbers easily.

      This is what gets lost in our health debate. The reality of the rest of the world.

    • Even the ‘continuous coverage’ guarantee that is offered by Republicans is often a bad joke in the real world.

      And I speak from experience. I was laid off from one job and struggled mightily to keep up with COBRA premiums. Then after 18 months I asked for my guaranteed issue continuous coverage plan.

      I was told that my old corporate insurer was in New Jersey, but I live in Minnesota so I had to find a Minnesota guaranteed policy.

      There are none in the private sector. If Minnesota had not offered a valid high risk pool, I would have no insurance today and I do have a heart condition.

      Romney could not care less about the uninsured. Unlike senior citizens, the uninsured do not vote in a block, and they are mostly so snowed in by life that they do not speak out on politics. They certainly do not make many contributions.