Republicans Debate: on Healthcare—Ho Hum

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This week’s health policy news roundup curated by Jane Orient, M.D.

Republican Presidential candidates all still say they want to repeal ObamaCare, but aren’t making much of an issue about it.

In the Nov 10 debate, Carly Fiorina pointed out that ACA is “crony capitalism at its worst. Who wrote this bill? Drug companies, insurance companies.” She said that “states should be encouraged to manage high-risk pools for those with pre-existing conditions and insurers should be required to be more transparent about their finances.”

She stated: “I’m a cancer survivor. I understand you cannot allow families to go bankrupt if they truly need help, but I also understand Obamacare isn’t helping anyone.” http://www.washingtonexaminer.com/fiorina-obamacare-is-crony-capitalism/article/2576080. What would this mean? Who would be required to “help,” and how?

Although Jeb Bush was decidedly nonassertive during the debate, he has previously acknowledged that Obamacare was “written by special interests, for the special interests,” reports Chris Conover. http://www.forbes.com/sites/theapothecary/2015/10/15/jeb-bush-nails-it-obamacare-is-a-cesspool-of-cronyism/

His “replacement plan” would accomplish some of its objectives simply by repealing ACA: most importantly, ending individual and employer mandates. It would “give” everyone the same “tax subsidy,” in the form of a refundable tax credit, to buy health insurance: an amount equal to the average tax subsidy for employer-based insurance. No more technical problems from the need to verify income to calculate the subsidy, it is claimed, but somehow low-income families would “surely get additional help.” http://www.forbes.com/sites/johngoodman/2015/10/13/the-jeb-bush-health-plan/

Bush would also cap the exclusion of employer-based health benefits from taxable income at $30,000 per family, writes John Graham. “This is reasonable limit to the traditionally open-ended exclusion, and much better than Obamacare’s punitive 40 percent excise tax (‘Cadillac tax’) on high value employer-based plans, due to kick in in 2018.” http://healthblog.ncpa.org/jeb-bushs-health-plan. This doesn’t seem to equalize the tax treatment of employer-owned insurance.

Bush doesn’t say how he would pay for the plan. Avik Roy calculates a static budget deficit increase of $750 billion. http://www.forbes.com/sites/theapothecary/2015/10/13/would-jeb-bushs-obamacare-replacement-increase-the-deficit/

Roy also notes that the Bush plan calls for modest FDA regulatory reforms, and making changes in health information technology recommended by his cousin Jonathan Bush, CEO of AthenaHealth.

What we haven’t seen from the candidates is a call for congressional investigations of ObamaCare, as recommended by John Goodman. http://www.forbes.com/sites/johngoodman/2015/10/23/what-republicans-should-be-doing-holding-hearings-on-obamacare/

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