A Conservative Re-Envisioning Of The Health Care Overhaul

Tired of hearing policy experts and politicians debate the 2010 health care law?  What if you took the Affordable Care Act out of the conversation?  If you could scrap the nation’s current health care system and build a new one, what would it look like?

A group of health care experts from Stanford University, the Harvard Kennedy School of Government and the University of Southern California, among other institutions, has compiled a report with their answer to that question.  Funded by the conservative-leaning American Enterprise Institute’s National Research Initiative, the document offers a variety of ideas that its authors say would achieve universal coverage, protect the poor and the sick and restrain health care cost growth, among other priorities.

“In many ways, the ACA has been a distraction, because people think that all of the health care debate boils down to ‘do you support the ACA or do you oppose it?’ ” said Darius Lakdawalla, one of the authors and a visiting scholar at the American Enterprise Institute, as well as a  professor of pharmaceutical economics in the University of Southern California School of Pharmacy. “To us, that is really a very narrow and misleading question.”

The report’s proposals include allowing health insurers to charge premiums that reflect consumers’ health care costs and providing generous subsidies to help the poor obtain coverage. Every consumer would have access to a basic health plan at no cost but could purchase more generous coverage if they wished. Employers would no longer receive a tax exemption for providing health insurance in an effort to de-link coverage from the workplace.

The document, discussed at an AEI forum Tuesday, would keep key elements of the 2010 health care law – its online marketplaces, or exchanges, where people purchase coverage, and its subsidies to help people buy coverage  — but structure them differently.  The AEI plan includes national or state run exchanges, but insurers would face far fewer restrictions governing how much they could charge for coverage. And while the health law provides subsidies for individuals and families with incomes up to 400 percent of the poverty level, the AEI plan would provide subsidies to individuals with extremely high medical costs up to 600 percent of the poverty level.

Unlike the health law, however, there would be no employer or individual mandates to provide or purchase  coverage or pay a fine. And the AEI plan would scrap Medicaid, the federal-state health insurance plan, and instead provide coverage through the exchanges with generous subsidies for the poorest and sickest. The health law expands Medicaid but states can decide if they want to participate.

In a health care world focused on implementing the 2010 health care law, the report authors realize their proposal may not get immediate traction.

“This is about changing the way people think about health reform,” said Lakdawalla.