So, what’s in Rand Paul’s Obamacare Replacement Act (S. 222)? I couldn’t find a convenient cut-and-paste, so I went to the act text myself and started listing the specifics. To make it easier on myself, I paraphrased in some instances. The text of the bill is here, so you can check it out for yourself.
Understand that this is what’s going on in the Senate as opposed to the House. Hopefully, the admixing of the two will provide an improved product. At this point in time, the (House) American Health Care Act is pretty bad, but Paul’s plan is much much better. It still doesn’t address entitlements, but it’s a step in the right direction.
- Repeal the individual and employer mandates, rating restrictions, rate review, essential health benefits requirement, medical loss ratio, and other insurance mandates.
- Provides 2-year open-enrollment period under which individuals with pre-existing conditions can obtain coverage.
- Restores HIPAA pre-existing conditions protections, which guaranteed those in the group market could obtain continuous health coverage regardless of preexisting conditions.
- Equalizes the tax treatment of the purchase of medical insurance for individuals and employers by providing a universal deduction on both income and payroll taxes regardless of how an individual obtains their insurance. This equalizes the premium burden between the individual and group markets while not interfering with the employer-provided coverage.
- Provides individuals the option of a tax credit of up to $5,000 per taxpayer for contributions to an Health Savings Account while allowing contributions contributions to remain tax preferred. It also removes the maximum contribution limit to HSA, so if you can save for surgery or extended care treatment. Eliminates the requirement that a participant in an HSA be enrolled in a high deductible health care plan. Also enables individuals who are eligible for Medicare, VA benefits, TRICARE, Indian Health Service, and health care sharing ministries to be eligible to establish an HSA.
- Allows HSA funds to be used to purchase insurance or pay insurance premiums.
- Allows an account holder to rollover HSA to spouse, child, parent, or grandparent.
- HSA’s would be protected similarly to retirement accounts during bankruptcy.
- Certain exercise equipment and physical fitness programs would be treated as medical care.
- Nutritional and dietary supplements would be treated as medical care.
- Doctor access fees could be paid from HSA funds.
- HSAs could be used for pre-paid physician fees, as in direct practice medicine.
- Allows Medicare enrollees to contribute their own money to the Medicare Medical Savings Accounts.
- Amends the Internal Revenue Code to allow a physician a tax deduction equal to the amount the physical would otherwise charge for charity medical care or uncompensated care due to bad debt, up to 10% of the physician’s gross income for the taxable year.
- Establishes Independent Health Pools (IHPs) to allow individuals to pool together for the purpose of purchasing insurance. This would include non-profit organizations, including churches, trade associations, etc.
- Requires that the IHP will provide insurance through contracts with insurance issues in fully insured plans and not self-insure.
- Allows insurers to sell policies in all states. (There are exceptions. Go to the text for clarity).
- Allows Association Health Plans (AHPs) which allow small businesses to pool together across state lines through their membership in trade or professional association. (In other words, small groups can now become large groups). While AHPs currently exist, strict ERISA requirements are nearly impossible to meet. (Again, a complicated point, so go to the text for clarity)
- Provides an exemption from Federal antitrust laws for health care professionals (excluded from the NLRA) engaged in negotiations with a health plan regarding the terms of a contract under which the professionals provide health care items or services.
- Provides new flexibilities to state in their Medicaid plan design, in order to test new coverage rules without interference from federal agencies.
- Amends the definition of “health insurance coverage) to clarify that stop-loss insurance is not health insurance. This is designed to prevent the federal government from using rule-making to restrict the availability of stop-loss insurance used by self-insured plans.
And, yeah, that’s the whole thing. It’s four pages. The highlighted text are the suggestions Rick has been making for years.
Rand Paul’s plan is much more free market than the GOP House plan. It still doesn’t go far enough, but it does away with most of the things in Obamacare that are going to bankrupt the middle class and the government and returns health care, medical care and medical insurance decisions to the people, where they should always have remained.