• Republican candidates’ stances on health care

    From the Associated Press in the WaPo. I’m going to take them one by one.

    HEALTH CARE:

    Gingrich: Repeal Obama’s health care law if Republicans win congressional majorities. Prohibit insurers from cancelling or charging discriminatory rate increases to those who become sick while insured, which is an element of Obama’s law. Offer the choice of a “generous” tax credit to help people buy health insurance or the ability to deduct part of the cost from taxes, another feature similar to the existing law. Limit medical lawsuits to restrain health care costs and let people in one state buy policies in another. “Block-grant Medicaid and send it back to the states.” Previously supported proposals that people be required to carry health insurance.

    Repeal the ACA? Check. But there’s a bit more. Speaker Gingrich supports cracking down on rescissions, which is fine, but not that controversial. He also wants to provide people money through the tax system to buy plans, but that is going to cost a lot of money. I sure hope he doesn’t think that tort reform will provide that money, because (1) it’s not going to be that much, and (2) what savings there is won’t go to the federal government necessarily. More on block grants, and why they aren’t the panacea some think they are here, here, and here. I’m a bit surprised by the “across state lines” proposal, as I thought that one had finally gone away, but he’s hitting all the high notes.

    Paul: Opposes compulsory insurance and all government subsidies for health coverage. Favors letting people deduct full cost of their health coverage and care from taxes. Says doctors should then feel an obligation to treat the needy for free.

    Repeal the ACA? Check. Someone needs to explain to Rep. Paul that allowing people tax deductions isn’t that much different from providing them subsidies. Either way, the government is using the tax system to help people pay for insurance. That’s going to cost a lot of money, and I’m curious how he’d pay for it. I don’t even know what to do with that last part. Doctors can’t magically create drugs, hospitalizations, and equipment with their compassion.

    Perry: Repeal Obama health care law. Raise eligibility age for Medicare benefits, limit benefits for the wealthy and give people the choice of receiving federal aid to help purchase their own insurance instead of getting the direct benefits of the current system. Proposes turning Medicaid over to the states with no-strings federal support. Texas has the highest percentage of uninsured people in the nation. Signed a law that would allow Texas — subject to federal approval — to band with other states and take over the role of providing health care coverage for the elderly, the poor and the disabled.

    Repeal the ACA? Check. But then Governor Perry doubles down by telling near-retirees that he wants to deny them Medicare until they are older. ARGH.It seems like he’s endorsing transitioning Medicare to a defined contribution program instead of a defined benefits program, and by leaving it a “choice” it may be that he’s more Ryan-Wyden than Ryan, but it’s impossible to tell. Means testing seems thrown in there, too, but won’t do much for the bottom line.

    Romney: Promises to work for the repeal of the federal health care law modeled largely after his universal health care achievement in Massachusetts because he says states, not Washington, should drive policy on the uninsured. Proposes to guarantee that people who are “continuously covered” for a certain period be protected against losing insurance if they get sick, leave their job and need another policy.

    Would expand individual tax-advantaged medical savings accounts and let the savings be used for insurance premiums as well as personal medical costs. Would let insurance be sold across state lines to expand options, and restrict malpractice awards to restrain health care costs. Introduce “generous” but undetermined subsidies to help future retirees buy private insurance instead of going on traditional Medicare.

    No federal requirement for people to have health insurance. His Massachusetts plan requires people to have coverage, penalizes those who don’t, and penalizes businesses of a certain size if they do not provide coverage to workers. His state has highest percentage of insured in nation. On Medicaid, proposes to convert program to a federal block grant administered by states

    Repeal the ACA? Check. He wants to expand HSA’s and allow premiums to be paid from them as well. I imagine this is to allow those buying insurance on the individual market to get tax deductions for insurance like those who get it from their employers do. If that’s the case, once again, that will cost a lot of money. Including tort reform. I assume his Medicare reform is more like Ryan-Wyden if it’s “generous”. And there’s the “across state lines” idea.

    Santorum: Would seek to starve Obama’s health care law of money needed to implement it, and to repeal it. Was a leading supporter of Bush administration’s prescription drug program for the elderly, which he now calls a mistake.

    Repeal the ACA? Check. I can’t tell from that last bit if he wants to repeal Medicare Part D, but I’m going to assume he won’t, as that would likely be electoral suicide.

    So there you have it. It seems clear that repealing the ACA is the one thing everyone can agree on. Of course, that would mean repealing all the spending cuts and potential cost controls, so that would hurt budget projections going forward even if you disagree with how much the benefits of the ACA would cost. There’s the usual bit of tort reform in some plans, and the usual bits about block granting Medicaid as well. A few candidates seem to endorse Ryan-Wyden, but details are scarce. Only one two candidates reach back for the “across state lines” thing.

    But I think the most interesting thing is how everyone seems against “subsidies”, but all for tax credits or deductions. I’m not sure the candidates realize that the subsidies in the ACA were going to be processed as tax credits (potentially “advancable”). These will be expensive, as they are in the ACA, and while I’m fine with them, I think it will be important for candidates who are running on a “slash spending” ticket to explain where that money is coming from.

    It’s still early in the campaign, and I expect more details will come out as time goes on. For the moment, these are just broad brush strokes. Once again, compared to four years ago, I’m shocked at how little the candidates have focused on this issue.

    UPDATE: An eagle-eyed reader notes that two candidates support the “across state lines” idea. Fixed the post.

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    • On Romney…
      I keep hearing this argument that it is fine for states to require health insurance (or anything else) but not the federal government.
      I just don’t understand it. The constitutional arguments are a grab bag of minutia which in the end will be decided by our partisan Supreme Court. Extensive and compelling arguments have been made on both sides of the issue.
      However, on a more basic level, both state and federal governments are representative governments where people get together for the common good and decide to tax and spend on various projects and activities to advance the public welfare. It really doesn’t make any difference if it is at the state level or the federal level (or even at the local government level). The effect is the same. The majority decides what to do and there will be some who are pleased and some who will feel put-upon… that’s government.
      I can understand the libertarian argument (but don’t agree with it) that everyone should be free to clean toilets to earn their right to a decent education. I just don’t see the difference between local, state and federal government. If you’re going to have government, this is what you get.

    • Looks like Gingrich wants the across state lines thing too: “Limit medical lawsuits to restrain health care costs and let people in one state buy policies in another”

    • I never realized that Ron Paul was a socialist.

    • The pseudo-policy about “buying insurance across state lines” is almost never fully explained.

      Here is what is really going on:

      In the 5 or 6 states that have community rating and no exclusions, premiums for young healthy men are very high.

      They must pay at least $600 a month for relatively meager policies.

      The reason is that these states do not allow underwriting, and they mandate maternity coverage in the individual market.

      By contrast, in the states which allow declines and exclusions, a young healthy male person can buy the same coverage for about $100 a month.

      Therefore, buying insurance across state lines will help these younger male customers.

      Of couses, This will cause even higher premiums in the guaranteed issue states,as healthy persons leave the pool in droves..

      There is a way to get through this macabre scenario. Guess what, it is called the public option, or fully funded high risk pools.

      These options might in fact be better than the ‘private sector socialism’ that the ;liberal states like New Jersey, NY, and Mass have been practicing..

      If covering sick people costs extra money, I am in favor of getting that money from general revenue; I would rather raise taces by $6000 on a rich older person, vs. forcing a younger worker to pay an extra $500 a month for guaranteed issue insurance.

      The test is, who will admit to higher taxes as an alternative to mandates????? Try John Goodman first, at least he is relatively honest,

      Bob Hertz, The Health Care Crusade