• A Quiz

    In what policy document is the follow passage found? I will answer tomorrow if it is not gotten correctly in the comments before then.

    Update: Benjamin in the comments was the first correct answer…the snip is from the 15 page background document circulated by Rep. Paul Ryan’s office in support of his Patients’ Choice Act. Here is the document (p. 5), initially released on May 20, 2009.

    While there are some important differences, I think of the PCA and the ACA as cousins. If we focused on the policy, a deal between these two plans could be worked out. The plans share state-based insurance exchanges in which to purchase private health insurance, both modify the current tax preference of employer paid insurance, both envision boards with experts seeking to improve the function of the health care system, both allow consumers to pick different types of plans, both provide federal support to purchase health insurance.

    The biggest differences are the subsidy levels provided to purchase insurance and the use of Medicaid to greatly aid in the expansion of insurance coverage in the ACA. Other key differences are the fact that the ACA has a penalty for not purchasing health insurance (individual mandate) while the PCA envisions auto-enroll procedures that are designed to get persons signed up for coverage. In both cases, I would love to know what the CBO thought about these differences. How similar would strong auto-enroll procedures be from a weak penalty for not being covered contained in the ACA? And if low income persons cannot be effectively covered by the level of subsidy offered in the PCA, that is worth knowing, isn’t it?

    In policy terms, I think a political deal has always been available given these similarities, but I don’t think it has been about the policy for some time. In any event, we need to hear from the CBO about the PCA.


    • Obama’s 2007 Health Care proposal

    • This looks like its straight out of Paul Ryan’s Patient’s Choice act…

    • Considering the caption of the picture is “PCA text”, I’ll go out on a limb and guess the Patients’ Choice Act.

    • Sen. Coburn’s health reform bill

    • Paul Ryan’s “Patients’ Choice Act”

    • This is from the so-called, Patient Choice Act proposed by Republicans several years ago to counter the President’s plan. It has supposed commitments to universal coverage, but not really the mechanics to achieve this objective. It touts MA plan (think: Romney) and pushes the impetus to the states.
      Chris Mitchell

    • Yes, it’s Paul Ryan Patient’s Choice Act. What prize do we get? (kidding)

    • The PCA adopts a Swiss-style profit-redistribution system for health insurers:

      “A non‐profit, independent board would penalize insurance companies that cherry pick healthy patients while rewarding companies that seek patients with pre‐existing conditions.” (page 5).

      I wonder how hard insurers would lobby against this plan if it ever had a chance of passing? There isn’t a non-profit requirement like the Swiss system has, but this has the potential to seriously cut into insurance industry profits. (And also isn’t a particularly shining example of “small government”).

      The PCA also fails the “if you like your insurance, you can keep it” test that was a central goal behind the ACA. Getting rid of the employer health care tax deduction and replacing it with a flat refund will all but ensure that everyone gets dumped into the exchanges.

      • @Albert
        an immediate ending of the tax preference of employer paid insurance makes it an arguably bigger step than ACA ever was. Biggest problem with PCA (other than level of subsidy too low) is that subsidy can be used inside and outside of exchanges, so big worry of death spiral inside. Once you start modifying PCA….slower change in tax preference, need bigger subsidy, etc. you basically end up with ACA. Real question is could you get auto enroll procedures that are effective enough and do away with ind mandate. Also, just cop to the fact that it is cata coverage and make extra cover available in exchanges. Again, on the policy, you could hash something out between the two. Key in Switz is high rate of people being in the system/purchasing cover

    • Patients’ Choice Act of 2009, sponsored by the infamous Rep Ryan, and by Rep Devin Nunes (R-CA).


      To be fair to the sponsors, they could counter that the ACA provides too much oversight, and that much of that oversight is counterproductive.

      (I was going to post this earlier but something came up at work)

      • @Weiwen Ng
        of course they could. my point is that in policy terms if we were working on coverage, cost and quality we could work out a deal