Republicans in Congress are slated to unveil their health care reform plan on Wednesday, a proposal that relies heavily on private mechanisms, contains no individual mandate, and offers tax incentives for families and individuals to help pay for coverage.
Tilted "The Patients' Choice Act of 2009," the plan will be introduced by U.S. Senators Tom Coburn, (R-OK) and Richard Burr (R-NC) and U.S. Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA) at 11 a.m. The focus of the proposal -- an advanced copy of which was obtained by the Huffington Post -- is to push for a "guaranteed choice of coverage" in the private market through federal-state partnerships know as State Health Insurance Exchanges.
Individuals, the authors write, will have a "one-stop marketplace" to choose plans in the exchange, including the option of keeping their employer coverage and/or existing insurer. "Participating insurers," meanwhile, would be required to "offer coverage to any individual -- regardless of patient age or health history" though there is no mandate for an individual to purchase that insurance.
Where the plan seems likely to run into strong opposition is in its efforts to drastically move the insurance market away from employer-based or publicly operated plans. As championed by John McCain during the presidential campaign, The Patients' Choice Act of 2009 effectively ends tax breaks for employers who provide health coverage to their workers, choosing instead to give a $5,710 tax cut to families and a $2,290 cut to individuals to help them pay for health insurance coverage. Critics insist that this system would end up costing both business and consumers more over the long term. And some objective analysts have agreed. After all, families are currently paying approximately $12,300 a year for health care today.
The notion that guaranteed choice can be achieved under the private market is also predicated on several debated notions. The first is that an effective enforcement mechanism can be put in place requiring private insurers to offer coverage. The authors call for the creation of a non-profit, independent board "to penalize companies that cherry-pick health patients." The second concern is that the market itself might consolidate. The latter is already promising to be a big problem, a Democratic critic of the plan notes, as studies show the HMO and Preferred Provider Organization industries to be "highly-concentrated, or anti-competitive, in 96% of metropolitan areas."
There are, finally, some budgetary concerns with the Republican proposal. The authors call for investing in chronic disease prevention for problematic, long-term illnesses -- including providing $50 million annually for increased vaccine availability. They pledge major administrative improvements in Medicaid and Medicare as well. And they promise to ensure compensation for injured patients by encouraging legal reforms. All of this will require spending, and eliminating the tax exclusions for employer coverage can only get them so far.