GOP Health Care Alternative

At the Republican response to the State of the Union address Gov. McDonnell of Virginia said viewers could find Republican solutions to today's problems at solutions.gop.gov. I checked it out.

The health care alternative links to an amendment to HR 3962 sponsored by Rep. Boehner of Ohio. It is 219 pages long. According to the statement of purpose the bill is intended to

take meaningful steps to lower health care costs and increase access to health care coverage (especially for individuals with preexisting conditions) without 1) raising taxes, 2) cutting Medicare benefits for seniors, 3) adding to the national deficit, 4) intervening in the doctor-patient relationship or 5) instituting a government takeover of health care. (p. 1)

The first 14 pages set out some basic guidelines. One of these says insurance companies cannot set annual or lifetime spending caps. It also says:

If a health insurance issuer determines to nonrenew or not continue in force, including rescind, health insurance coverage for an individual in the individual market on the basis described in section 2742(b)(2) before such nonrenewal, discontinuation, or rescission, may take effect the issuer shall provide the individual with notice of such proposed nonrenewal, discontinuation, or rescission and an opportunity for a review of such determination by an independent, external third party under procedures specified by the Secretary.

INDEPENDENT DETERMINATION.—If the individual requests such review by an independent, external third party of a nonrenewal, discontinuation, or rescission of health insurance coverage, the coverage shall remain in effect until such third party determines that the coverage may be nonrenewed, discontinued, or rescinded under section 2742(b)(2). (p. 13-14)

Is that a rescission panel?

Among the strategies for cutting health care costs are giving bonuses to states that cut per capita premium costs, create or contract out the development of health care plan finders to help citizens find health care plans.

The section of small businesses takes up 63 pages (pp. 51-114), nearly 25% of the entire bill. I don't know enough to comment on what is said here.

Children can be covered on parent's policies until age 25 and spouses can be automatically enrolled.

Nearly 30 pages (118-146) are devoted to allowing Americans to buy health care coverage across state lines. To me the key provision here is on pages 129 and 130 that policies sold across state lines be labeled (in 12 point bold type):

"This policy is issued by [ ] and is governed by the laws and regulations of the state of [ ], and it has met all the laws of that state as determined by that state's department of insurance. This policy may be less expensive than others because it is not subject to all of the insurance laws and regulations of the state of [ ], including coverage of some services of benefits mandated by law of the state of [ ]. Additionally, this policy is not subject to all of the consumer protection laws or restrictions on rate changes of the state of [ ]. As with all insurance products, before purchasing this policy, you should carefully review the policy and determine what health care services the policy covers and what benefits it provides, including any exclusions, limitations, or conditions for such services or benefits."

In other words, selling across state lines means you can buy a policy created in a state that has lower standards than yours. The insurance is cheaper because it is lower quality.

There are six pages on medical savings accounts. Medical Liability Reform takes up pages 150-168. I don't know enough about this topic to comment in any details.

In keeping with their view of limited government, this bill allows health insurance companies to charge policy holders more or less (by 50%) depending on their participation in wellness programs.

Suppliers and providers applying to be approved by medicare will pay an application fee to cover background checks. There is a section that appears to call for digitizing medicare medical records to track waste and fraud.

While the bill does call for no federal funds to be used for abortions it does have exceptions to this rule for rape, incest or "the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performance, including a life-endangering physical condition caused by or arising from the pregnancy itself." (p. 174).

The last 34 pages are devoted to "biosimilar biological products." Wikipedia will give you a basic explanation of this, but in uneducated layman's terms it allows for creation of generic-like forms of things like insulin. There are medical complexities to this. You'll have to read it yourself to decide if this section is pro or con biosimilar. If this term sounds familiar it is because there was a press flap over HR 1548 (Pathways for Biosimilars Act) because lobbyists had asked members of Congress (from both parties) to insert comments on the bill into the congressional record. (See "In House many spoke with one voice: lobbyists" by Robert Pear)

In any event, roughly 15% of the Republican health care plan deals with licensing of biosimilars.

That is, in brief summary, what I could get out of the GOP Health Care Alternative Plan, and I encourage you to review it for yourself.