That unscripted remark by South Carolina GOP Representative Joe Wilson during President Obama’s healthcare address to Congress last month was a prime example of the level of dissent and anger which has surrounded the healthcare debate. There is significant disagreement as to not only the nature and extent of the problem with the American healthcare system, but also as to the solution. The misrepresentations and distortions have reached historic levels, and gutter-level political discourse has at times reached epic proportions. No tax increases on the middle class. Death squads. No coverage for abortions. Kill Grandma. No coverage for illegal aliens. Increase competition with a public option. The list of talking points heard nearly every day across the country is long and at times ugly.
One particular favorite of liberal Democrats is that the Republicans have brought nothing to the table and are The Party of No. To counter this ridiculous assertion, House Republican Study Committee Chairman Tom Price (R-GA) has distributed a full listing of healthcare solutions offered by members of the RSC. The list now includes more than 40 bills offered by RSC members this year alone, none of which have been considered by Speaker Pelosi and the Democrat majority either in committee or on the House floor. Here is just a sample of the bills which the House has refused to consider, month after month after month:
H.R. 109 – America’s Affordable Health Care Act of 2009 (Fortenberry, R-NE)
Introduced: January 6, 2009
Summary: America’s Affordable Health Care Act seeks to promote more affordable insurance options for individuals who do not receive health coverage through their employer, and also for those with complex or chronic health conditions. It permits insurance companies to offer policies with fewer mandated benefits, called “health benefit plans.” It would allow individuals and families who do not receive health insurance coverage through their employer or from the government to have the option of purchasing one of these lower cost health benefit plans. These plans would be required to cover, at minimum, inpatient hospital services and physicians’ surgical and medical services.
More specifically, it authorizes a health insurance issuer to apply to the Secretary of Health and Human Services to certify health insurance policies offered in the individual market as Health Benefit Plans. It will allow these certified plans to be offered to individuals in all states without regard to state and local mandated benefit laws. This legislation recognizes that for every mandated benefit, a certain segment of the population is priced out of the market and cannot afford health care coverage. Mandates may benefit the employer market, but can price individuals out of the individual market.
This legislation enhances coverage opportunities for those with complex or chronic conditions, by providing more funding to states for high-risk pools. High-risk pools offer insurance coverage options to individuals with pre-existing medical conditions who are otherwise unable to obtain insurance in the individual market. Specifically, it amends the Public Health Service Act to increase the authorization of appropriations for FY2010-FY2014 for grants to states for the creation and operation of qualified high risk health insurance pools. It also authorizes funds to encourage state to adopt best practice protocols regarding the operation of high risk pools.
H.R. 270 – TRICARE Continuity of Coverage for National Guard
and Reserve Families Act of 2009 (Latta, R-OH)
Introduced: January 7, 2009
Summary: This legislation allows retired members of the National Guard and Federal Reserve Components with 20 or more years of faithful and honorable service to purchase healthcare that was available to them during their time in active service or after they reach 60 years of age. Currently, members who have retired but are not yet 60 years of age are not eligible for TRICARE health insurance, and are referred to as being in the “gray area.” Right now there are approximately 220,000 retirees that fall within the “gray area,” with an additional 12,100 service members retiring and entering this status each year. CBO has not scored the legislation, however since this would allow “Gray Area” reservists to purchase TRICARE Standard health coverage at 100% of the premium, the sponsor office notes that the costs would be fully offset.
H.R. 1118 – Health Care Choices for Seniors Act (Blackburn, R-TN)
Introduced: February 23, 2009
Summary: Once an individual turns 65, he or she must sign up for Medicare Part A in order to receive Social Security payments. Once signed into Medicare, individuals can no longer contribute tax-free into their Health Savings Account. This bill allows individuals to opt-out of joining Medicare until age 70, while allowing them to still receive Social Security benefits. Also, if an individual chooses to opt out of Medicare, he or she will receive a voucher that is actuarially equivalent to the average (mean) Medicare payments to all individuals of that same age in the Medicare Part A program.
By allowing individuals to wait to join Medicare, this allows the individual to continue their pre-tax contributions to the HSA. By delaying Medicare penalties to the age of 70, this takes away one significant incentive for individuals to automatically join at 65. It allows 5 more years for individuals to choose when they want to join Medicare, stay with their private insurance company for a few years, or the opportunity to join Medicare for a few years, and switch back.
The legislation caps the age that people can switch back and forth at 70. Most health issues occur in later years of life, so by forcing an individual to make the decision at 70, it requires that person to start paying premiums at that time or face penalties if they sign up later. Enrollment dates for Medicare will remain the same. Currently, Medicare enrollment at age 65 has a seven-month grace period. It begins three months before the 65th birthday, includes the month of turning 65 and ends three months after that birthday. If the senior does not enroll during this initial enrollment period, each year he/she is given another chance to sign up during a general enrollment period from January 1 through March 31. Coverage would begin the following July. An individual cannot just sign up for Medicare and have benefits start automatically. There would be a time period in between signing up and coverage so it would not be easy to go back and forth.
H.R. 1468 – Medical Justice Act of 2009 (Burgess, R-TX)
Introduced: March 12, 2009
Summary: The Medical Justice Act sets forth provisions regulating civil actions for an injury or death as the result of health care based on successful reforms adopted by the State of Texas. Caps will be placed on non-economic damages against healthcare practitioners and institutions. Caps will also be set on for wrongful death awards. This legislation also requires expert reports to be provided, and allows the payment of future damages to be made on a periodic or accrual basis.
The amount a person will be entitled to for non-economic damages will be set at $250,000 from a single institution or class of practitioner and $500,000 from a class of institutions for a total possible non-economic cap of $750,000 in some cases. The cap on a wrongful death award from a single healthcare practitioner will be set at $1,400,000 total. This amount includes compensatory, punitive, statutory, and other types of damages, and will be adjusted for inflation. The jury must be unanimous in both the liability of the practitioner and the amount of the award. A claim must be brought within 2 years of when the negligence or the health care on which the claim is based occurs. For individuals under age 12, a claim must be brought before the individual reaches age 14.
Not later than 120 days after filing, the party filing must present to the other parties a qualified expert report. This report is a written report by a qualified health care expert that includes a curriculum vitae of the expert, and a summary of the opinion as to the standard of care applicable, how that standard was not met, and the relationship between the two. This report may not be used during trial.
A defendant may initiate a settlement by serving one or more qualified offers to the person seeking damages. If the qualified settlement offer is not accepted and the offeree receives a judgment at trial that is significantly less favorable than that offer, the offeree is responsible for the litigation costs of the defendant.
Also, a health care practitioner that provides emergency health care on a Good Samaritan basis is not liable for damages except for willful or wanton negligence or more culpable misconduct.
H.R. 2520 – Patients’ Choice Act (Ryan, R-WI)
Introduced: May 20, 2009
Summary: The Patients’ Choice Act would transform health care in America by strengthening the relationship between the patient and the doctor by using the forces of choice and competition rather than rationing and restrictions. It seeks to ensure universal, affordable health care for all Americans.
The Patients’ Choice Act invests in prevention by establishing an Interagency Coordination Committee that will develop a national strategic plan for prevention. It also requires the development of a science-bases nutrition counseling brochure to be distributed to food stamp recipients and prohibits the purchase of foods that do not meet science-bases standards for proper nutrition.
This legislation outlines the requirements for certification of state-based health care exchanges to facilitate the purchase of innovative private health insurance. States are not required to create exchanges but have the option to do so. Any health insurance plan licensed in the state may participate in the exchange, but plans are not required to participate. Plans may still sell health insurance outside the exchange.
Under this bill, States may develop automatic enrollment procedures to ensure that any individual seeking health coverage has the opportunity to enroll in a plan of their choice. No one will be required to enroll in health insurance coverage. Plans offered through this exchange may not discriminate based on pre-existing conditions, so individuals are guaranteed access to a health insurance plan through the exchange.
Qualifying individuals will be eligible to receive an advanceable, refundable credit of at least $2,290 and $5,710 respectively in 2010, with subsequent annual cost-of-living adjustments. Should the credit exceed the cost of a health insurance product, the excess amount will be deposited into a medical savings account, or a health savings account.
The current individual income tax exclusion for employment-based heath benefits will be converted into a tax cut for taxpayers. The exclusion of health benefits from FICA payroll taxes remains. Contributions made by employers toward employee health care are still deductible as a business expense deduction.
Long-term services in Medicaid will be expanded to include an array of services, including assistive technology, community treatment teams, recovery support, and transitional care without the need for federal waivers. The legislative reorganization includes authorization of $100 million annually in new grants to states for program integrity. It also includes authorization of $100 million in outreach grants and transition rules to ensure seamless transition and effective continuation of care.
The legislation also aids low income families. Each eligible family that enrolls in the supplemental health care assistance program shall be issued a debit card with a dollar-amount value that may be used to pay for qualifying health care expenses. Families whose annual income does not exceed 100% of the poverty level will be provided $5,000. Families whose annual income is between 100% and 120% will receive $4,000. An additional $1,000 is made available for each family in which there is a pregnancy during a 12-month period. An additional $500 is made available for each member of the family under the age of 1 year old.
Fixing Medicare is also a key part of this legislation. Inefficiencies will be eliminated to increase choice in Medicare Advantage. Wealthy Medicare beneficiaries will be required to contribute a little more for their care under Medicare Part D, and all seniors will be rewarded for preventative healthy behaviors.
Reform to tort litigation for medical malpractice claims is also a key part in reigning in out of control health care costs. Funding will be available for States to establish review panels or health care tribunals. Qualifying review panels will be comprised of medical experts and attorneys appointed by the state who review health care claims and make a determination as to the liability of the parties involved. Parties may reject the determination and file a claim relating to the injury in a state court. Any party filing in state court forfeits awards from panel determination. Qualifying health care tribunals are composed of judges with explicit expertise in health care litigation who review cases at the request of individuals who have a health care claim. After review of the case, the tribunal would make a determination as to the liability of the parties involved. Parties may reject the determination and file a claim relating to the injury in a state court. The third option allows states to utilize a combination of the review panel and health care tribunal.
H.R. 2786 – Patient Fairness and Indigent Care Promotion Act of 2009 (Thornberry, R-TX)
Introduced: June 10, 2009
Summary: The Patient Fairness and Indigent Care Promotion Act would help doctors treat low-income patients by allowing them to deduct the costs of treatment as a bad debt write-off from their federal taxes. This measure will help provide incentives to doctors to treat more non-paying patients. The bill will also save the health care industry money because it is almost always more expensive to treat individuals in emergency rooms than in doctors’ offices. As you know, the median cost of an emergency room visit is nearly five times the cost of a typical office visit, so the more people out of the emergency room, the more money saved throughout the entire health care system.
H.R. 3400 – Empowering Patients First Act (Price, R-GA)
Introduced: July 30, 2009
Summary: The Empowering Patients First Act aims to increase patients’ control over their health care decisions by offering more choices and the highest quality available. This legislation is centered on granting access to patient-controlled health insurance coverage for all Americans, while improving the health care delivery structure and reining in out-of control costs. There are limitations on federal funds being used for abortions, and this legislation only applies to legal permanent residents or citizens of the United States.
The purchase of health care will be made financially feasible using a hybrid tax structure. The income tax deduction on health care premiums will be extended to those who purchase coverage in the non-group/individual market. This deduction will be above the line, and will be capped to allow for a deduction up to the average value of the national health exclusion for employer sponsored insurance indexed for inflation. A low income tax credit will be provided for premiums on a sliding scale, phased out as income increases. The credit will be based on the average health care insurance costs across the U.S., offered at $2,000 for an individual, $4,000 for a couple, and $5,000 for a family. This credit will be advanceable and refundable for individuals and families up to 200% of the federal poverty level. It will be a phased out credit from 200% to 300% of the federal poverty level.
The Empowering Patients First Act will also allow individuals the choice to opt out of federal benefits, the Federal Employees Health Benefit Program (FEHBP), and employer subsidized group health plans. For example, an individual will be allowed to opt out of Medicare with the ability to retain their Social Security benefits.
This legislation protects employer-sponsored insurance by allowing for an employer to auto-enroll employees with an opt-out. Small businesses will receive tax incentives for this adoption. Employers will be required to disclose on their W2 Form the annual amount the employer spends on the employee’s premium.
Improvements will also be made in the individual market by incorporating pooling mechanisms for small businesses (from H.R. 2607 by Congressman Johnson) and for individual membership accounts (from H.R. 3218 by Congressman Shadegg). Also incorporated will is H.R. 3217 by Congressman Shadegg, which will allow individuals to shop for insurance across state lines. An individual in a state may only shop across state lines if their state premium exceeds 10% above the national average. Those with pre-existing conditions or high health care needs will also be ensured coverage by an increased federal block grant for functioning, qualified high risk pools. States will not receive credits unless they establish a pool meeting certain criteria.
A key way to rein in on out-of-control costs is through medical liability reform. Caps on non-economic damages will be established by incorporating Congressman Gingrey’s HEALTH Act of 2009 (H.R. 1086). Affirmative defense measures will be put into place through provider-established best-practice measures. There will be no presumption of negligence if a participating physician does not adhere to the guidelines.
Medicare reform is necessary, and this legislation will reform Medicare physician payments. It will rebase SGR and establish two separate conversion factors, one for primary care and one for all other services.
There will also be incentives for physicians. Primary care physicians will receive help with loan repayment, up to $50,000 after 5 years of practice. There will be a Health Professional Student Loan (HPSL) program created for medical schools which allow the deferment of payments until after full residency and any fellowship training programs are completed. Also, Emergency Room physicians will be allowed to receive a deduction for uncompensated care.
Also incorporated in this legislation are portions of H.R. 3176 from Congressman Barton in the 110th Congress. States will be required to cover 90% of SCHIP eligible individuals below 200% of the federal poverty level first before they can expand current eligibility levels. There will be vouchers to purchase Medicaid & SCHIP, and any unspent money will be refunded based on the state/federal share unless the enrollee has an Health Savings Account (HSA). The State will be required to include pathways for premium assistance for employer sponsored insurance as part of the State plan.
This legislation will also allow for employers to offer discounts for healthy habits. There will also be HSA clarification for the treatment of capitated primary care payments as amounts paid for medical care. This provision is also found in H.R. 2520 by Congressman Ryan.
H.R. 3478 – Patient-Controlled Healthcare Protection Act of 2009 (Gohmert, R-TX)
Introduced: July 31, 2009
Summary: The Plan would provide incentives for employers, employees and the self-employed to purchase private insurance with a high deductible, while paying into a Health Savings Account (HSA). There is no limit on the amount that may be placed in the HSA, and any amount not used rolls over. It can also be gifted to other individuals’ HSA, inherited by the HSA of heirs, and accessed by a debit card coded for healthcare purchases only.
Anyone eligible for Medicare, Medicaid, SCHIP or any combination has the option each year of having the federal government purchase private insurance with a high deductible, while also funding cash into a Health Savings Account that covers the deductible. This plan would put the country on a correction course to actually save money on healthcare each year, all while giving patients the control and coverage we have long desired.
This plan provides patients both choices and security, allowing the selection of the doctor you choose without interference from an insurance company or government bureaucrat. The legislation further provides for complete transparency in the cost of healthcare by requiring healthcare providers to produce a list of charges for procedures, treatments, or expenses to any potential patient, as well as the prices that are charged to other entities. Also, anyone seeking to travel or immigrate to the United States must provide proof that they will have full healthcare coverage while here. Such coverage may be through a sponsoring employer or a resident in whose household the immigrant intends to reside. Otherwise, a visa will not be granted. If healthcare coverage ceases while the migrant is here, then the visa expires. If someone who is illegally in the U.S. requires free healthcare, that alien will get it as the law requires, then be deported. Anyone who has been deported following the receipt of free healthcare, and is found again illegally in the U.S., will be guilty of committing a felony. The bill sponsor notes, “We simply cannot allow immigrants coming here illegally to bankrupt this nation so immigrants have no United States to come to legally. This will also protect the free market principles on which our nation was founded. This plan gives patients complete control and complete coverage that is affordable and accessible. Medicine will once again be about the patient’s needs and the doctor’s diagnosis, with true competition like we haven’t had in a very long time, if ever.”
H.R. 3610 – Health Savings and Affordability Act of 2009 (Austria, R-OH)
Introduced: September 22, 2009
Overall: The Health Savings and Affordability Act makes improvements and expansions to Health Savings Accounts (HSAs), as well as makes health care insurance tax deductible for everyone. Currently, individuals who receive health insurance through an employer-sponsored program pay for these benefits with pre-tax dollars. Those who pay for their own health insurance out-of-pocket, pay for their plans with after-tax dollars. To correct this disparity and improve fairness, this bill provides for a tax deduction for qualified health insurance costs for individuals who purchase their own health insurance.
Current law allows HSA-eligible spouses 55 and older to make additional catch-up contributions to their HSAs. However, these catch-up contributions must be deposited into separate accounts even if both spouses are eligible to make catch-up contributions. This bill allows both spouses, if both are 55 or older, to make catch-up contributions to one HSA account even if a spouse is not a beneficiary of the account.
Some family plans have both individual and family-as-a-whole deductibles. Under current law, family coverage plans with both individual and family-as-a-whole deductibles do not qualify as High Deductible Health Plans (HDHP) if both of the deductibles do not meet the minimum annual deductible for family coverage. This legislation would qualify family plans with both individual and family-as-a-whole deductibles as HDHPs if either the individual or family deductible meets the minimum deductible for qualified HDHPs.
This legislation would eliminate some of the requirements previously placed on rolling over unused funds from employer sponsored Flexible Spending Arrangements (FSAs) and Health Reimbursement Arrangements (HRAs). Additionally, this legislation would prohibit the “use it or lose it” stipulation of FSAs if there is a balance left on the account at the end of the year. It also allows for a one-time unlimited roll-over from an FSA or HRA into an HSA, and eliminates the additional 10 percent tax for failure to maintain an HDHP.
This legislation would allow for certain exercise equipment and physical fitness programs to be treated as a qualified medical expenses, which would in turn allow for a medical expense tax deduction up to $1,200 when taxpayers itemize.
In this new era of bipartisanship and transparency promised by President Obama, one would think something in this rather lengthy list might be worthy of consideration. Perhaps Speaker Pelosi is under the mistaken impression that by not considering Republican bills, they do not exist. Perhaps yet another lie to the American people is easier than discussing options that might require compromise. Perhaps this is one of the reasons Republicans and conservatives are, as our President so eloquently put it, “gettin’ wee weed out.”