{"id":642,"date":"2014-01-28T07:56:00","date_gmt":"2014-01-28T07:56:00","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/2014\/01\/dissecting-the-patient-choice-affordability-responsibility-and-empowerment-act.html"},"modified":"2014-01-28T07:56:00","modified_gmt":"2014-01-28T07:56:00","slug":"dissecting-the-patient-choice-affordability-responsibility-and-empowerment-act","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2014\/01\/dissecting-the-patient-choice-affordability-responsibility-and-empowerment-act.html","title":{"rendered":"Dissecting The Patient Choice, Affordability, Responsibility, and Empowerment Act"},"content":{"rendered":"<!DOCTYPE html PUBLIC \"-\/\/W3C\/\/DTD HTML 4.0 Transitional\/\/EN\" \"http:\/\/www.w3.org\/TR\/REC-html40\/loose.dtd\">\n<html><head><meta http-equiv=\"content-type\" content=\"text\/html; charset=utf-8\"><meta http-equiv=\"content-type\" content=\"text\/html; charset=utf-8\"><\/head><body><p>Is it worth the wait? Is this promised \u201cObamaCare replacement\u201d any good? <\/p>\n<p>Let\u2019s call this live-blogging of the <a href=\"http:\/\/www.coburn.senate.gov\/public\/index.cfm?a=Files.Serve&amp;File_id=871b0ef8-7705-4f72-aef2-e81d01b9c009\" class=\" decorated-link\" target=\"_blank\" rel=\"nofollow\">proposal from Senator Coburn<\/a>, found, among other places I\u2019m sure, on the <a href=\"http:\/\/www.weeklystandard.com\/blogs\/burr-coburn-hatch-proposal_775467.html\" class=\" decorated-link\" target=\"_blank\" rel=\"nofollow\">weeklystandard.com <\/a>site. <\/p>\n<p>Ready? Here goes: <\/p>\n<p>Section 101: ObamaCare to be repealed in full. <\/p>\n<p>Sectiono 201: adopt consumer protections. 1) no lifetime limits. 2) Move from a 3:1 old:young premium ratio to a 5:1 ratio as a baseline, but permitting any state to opt out and elect alternate ratios, or none at all. 3) keep the dependent coverage to age 26, but allow any state to opt out. 4) Guaranteed renewability: regardless of health status. <i>Good, good, good, good.<\/i><\/p>\n<p>Section 202: pre-exsiting condition protections. Any individual can change health insurance plans, whether in individual, small group, or large employer markets, without medical underwriting, so long as they\u2019ve been continuously enrolled in a health insurance plan with \u201cat least catastrophic coverage\u201d for at least 18 months. In addition, a one-time open enrollment period would provide an enrollment opportunity for all. <i>Not quite right: given the large difference between a plan with a $10,000 deductible and a $100 deductible, it shouldn\u2019t be permitted to switch from one to the other upon getting sick, either.<\/i><\/p>\n<p>Section 203: \u201cEmpowering Small Business and Individuals with Purchasing Power.\u201d Targeted tax credit for \u201ccertain individuals\u201d to buy health care \u2014 that is, those working for employers with less than 100 employees, but with no requirement to buy any particular sort of coverage. Credits for individuals with income up to 300% of poverty line \u2014 refundable, advanceable, phased out over 200% to 300% of poverty, increasing at CPI + 1%. Three age bands, and different amounts for individuals &amp; family, from $1,560\/$3,400 at age 18 \u2013 34 to $3,720 \u2013 $8,810 at 50 \u2013 64. <i>This is the most poorly thought-out part. Why only three age bands? These credits need to be based on the age and sex of every family member. And why only employees of small employers? It leaves those working for large employers without health insurance just as stuck as before. (Though the text was confusing on this point \u2014 maybe poor editing masked an intention to cover more people.) There\u2019s also no explanation of how credit eligibility and amounts work for married couples. <\/i><\/p>\n<p>Section 204: More Tools for States. States can randomly default non-enrolling individuals in to a plan with premiums equal to the value of the tax credit, though individuals can switch or even opt-out altogether. Funding for high-risk pools at the state level. Small businesses can negotiate small business health plans. States can enter interstate compacts for pooling and reduced administrative cost. <i>Fine. Fine. Fine.<\/i><\/p>\n<p>Section 204 (the editing was poor; there are two section 204s): Expansion of consumer-directed healthcare. Removal of restrictions on OTC medications, and use of veterans and others of health savings accounts. Allow HSAs to pay premiums for LTC insurance, COBRA premiums, and HSA-qualified policies. <\/p>\n<p>Section 301: Medicaid reforms. Medicaid recipients can also elect to use the tax credit. Fixed amounts to states, allocated based on #s below poverty line, growing at CPI + 1%. <\/p>\n<p>Section 302: reauthorize Health Opportunity Accounts, demonstrating program implementing savings accounts + high deductible plans for Medicaid. <\/p>\n<p>Section 401: Medical malpractice reforms, such as an \u201cAdministrative Health Care Tribunal\u201d <\/p>\n<p>Section 501: transparency requirements. <\/p>\n<p>Section 601: Cap the tax exclusion for employee\u2019s health coverage at 65% of an average plan\u2019s costs, growing at CPI + 1%. Repeal employer mandate. <i>I read something earlier indicating that this probably means 65th percentile. Not sure how this plays out over the long term.<\/i><\/p>\n<p><b>The bottom line: <\/b><\/p>\n<p>The biggest problem with this proposal is that the tax credits are still very poorly thought out. The one improvement on prior proposals is that at least there are age bands on the credits, but that\u2019s such a small improvement, and other parts of the proposal are still flaky and so undefined as to indicate that there\u2019s not much thought put into the proposal, such as the distinction between large and small employers as far as eligibility. <\/p>\n<p>What next? It\u2019s disappointing. I suppose that\u2019s why there\u2019s so little reporting on this proposal. And this is where I really wish there was some value in the old counsel to \u201cwrite your Senator.\u201d <\/p>\n<p>UPDATE:  The more I think about it, the more appalled I am that this proposal, which was spoken of so favorably at <a href=\"http:\/\/www.weeklystandard.com\/blogs\/burr-coburn-hatch-proposal_775467.html?page=1\" class=\" decorated-link\" target=\"_blank\" rel=\"nofollow\">The Weekly Standard<\/a> and the <a href=\"http:\/\/www.nationalreview.com\/corner\/369549\/obamacare-replacement-senate-yuval-levin\" class=\" decorated-link\" target=\"_blank\" rel=\"nofollow\">National Review<\/a>, is such a bust, and, it seems to me, likely to be just as ignored as every proposal before it.<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"<p>Is it worth the wait? Is this promised \u201cObamaCare replacement\u201d any good? Let\u2019s call this live-blogging of the proposal from Senator Coburn, found, among other places I\u2019m sure, on the weeklystandard.com site. Ready? Here goes: Section 101: ObamaCare to be repealed in full. Sectiono 201: adopt consumer protections. 1) no lifetime limits. 2) Move from [&hellip;]<\/p>\n","protected":false},"author":2209,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-642","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Dissecting The Patient Choice, Affordability, Responsibility, and Empowerment Act<\/title>\n<meta name=\"description\" content=\"Is it worth the wait? Is this promised &quot;ObamaCare replacement&quot; any good? 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