Advocates for Evidence-Based Health Policy Speakers
Republican Options for Heath Reform in 2020
“Repeal and Replace” became the chant of the Republican Party, reflecting the opinion of GOP leaders that the Affordable Care Act (ACA) had to be repealed as rising insurance premiums plagued the country. The party’s market-based solution to the flaws of the U.S. healthcare system came in the form of the 2017 American Health Care Act which ultimately failed in the Senate in a 49 to 51 vote. Around the time of its defeat, Senators Graham, Cassidy, Heller, and Johnson drafted legislation that used a state innovation-based approach. Because President Trump will likely adopt this model for his 2020 reelection platform, it is critical that voters thoroughly understand this approach.
The three primary objectives of the state innovation-based approach are to decrease cost, create block grants to give states more flexibility for market-based innovation, and increase non-standardized coverage options. Potential complications have been identified as the reduction of Medicaid funding by 1 trillion dollars which would lead to an increase in the uninsured population and decreased consumer protections. Although the legislation never received a vote, conservative think tanks have begun to frame suggested reforms based on this model, with proposals retaining key elements of the state innovation-based approach, such as expansion of consumerism, work requirements, frequent eligibility redetermination, and block grant financing for states.
In this article, Chen offers suggestions to increase mass appeal for the state innovation-based approach. He first suggests to increase consumer protections through state guidelines mandating that set percentages of block grants help low-income populations purchase health insurance and decrease premiums. He then suggests that when deciding the amount of each state’s block grant, population risk factors and size of the low-income community should be considered in order to support states during public health crises and economic downturns. He also encourages preservation of certain elements of the ACA such as prohibiting insurance companies from denying consumers coverage based on preexisting conditions. Lastly, he encourages premium assistance via a mechanism other than tax credits because low-income communities cannot afford to wait until taxes are filed to reap the financial benefits.
In this upcoming election, expect voters to voice their opinions on the Republican’s state-innovations based approach to healthcare reform and weigh the consequences of block grants against alternative proposals from the Democratic Party.
This Policy Prescriptions® review is written by Saira Alex as part of our collaboration with the Health Policy Journal Club at Baylor College of Medicine where she is a medical student.
Abstract
The 2020 presidential election will be consequential for the future of health reform, with the two major-party nominees taking very different views on the future of the Affordable Care Act (ACA), as well as the policies needed to lower health costs and continue to expand access to coverage. The Republican nominee will likely signal broad opposition to the ACA and a desire to replace it with a state innovation-based approach to reform, based on the Graham-Cassidy-Heller-Johnson legislation considered by the Senate in the fall of 2017. This article takes that legislation as a starting point, contextualizes it within the broader health reform discussion, and suggests ways to improve upon it to enhance the affordability of and access to coverage and to ensure that states have adequate flexibility to implement their policy goals.
PMID: 30444425
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