Although everyone is focused on Nazis and dead Confederate soldiers these days, the policy wonk of my brain is looking at health care reform. The U.S. Senate failed to come up with an alternative to the Affordable Care Act. While I have never been a big fan of Obamacare, I don’t believe in doing any repeal without a replace, because that would make things worse. And the “replace” should be somewhat thoughtful. So here are a few of my thoughts:
– Scale back the federal government’s role in Medicaid and start turning things over to the states. Like HIP 2.0, states are a lot more likely to know what their citizens need rather than a bureaucrat in Washington, D.C. The federal government can provide block grant funding to the states and give them guidelines to work from. After that, let the states have at it. We did this with welfare reform back in the 1990s.
– Get rid of employer-provided health care. I’ve always argued part of the problem with health care is most people get it through their jobs, and that means if you lose your job, your insurance goes with it. Treat health insurance like car, life and home insurance. You go out and buy a plan that works best for you and your family.
– Keep the individual mandate. My conservative friends won’t like this one, but I think it’s necessary. Part of the problem with health care costs is the people who don’t have coverage end up using the emergency room for health care, usually when it’s too late, and we all foot the bill. At least this way, some of those costs are deferred.
– Make hospitals and health care providers disclose their prices. If my car is having trouble, I can call my mechanic, and he can give me an estimate that’s pretty much right on the money. Why can’t I get this from a hospital? I understand the human body can be a little tricky, but give me something to work with, people.
– Allow for the sale of insurance across state lines. Proponents say this will encourage competition and drive down costs. The only problems are, who will regulate the product and where does a consumer go if they have a problem? As long as the Indiana Department of Insurance has the apparent authority and jurisdiction to resolve my issue with the policy I bought in the state of Washington and they won’t send me to some bureaucrat in Olympia, I think we can work this out.
– Give consumers more flexibility with their Health Savings Accounts. Let them save more money, and when they die allow those dollars to be inherited tax-free without having to jump through a lot of IRS hoops.
– Allow states to create regional risk pools for pre-existing conditions. I don’t believe anyone should be denied coverage for a pre-existing condition, but they also shouldn’t be allowed to pay the same as someone who doesn’t have one. The trick is always trying to figure out how to keep costs under control for that population. I think allowing states to create regional risk management pools can go a long way toward mitigating the costs associated with the pre-existing condition population.
– A “self-sufficiency” requirement. One of the goals of any state-run health care plan should be to get as many people off of it as possible. This is why I believe in the “work requirement” portion of HIP 2.0. For those folks who are able-bodied, let’s get them to work or at least improve their skill sets so they can become self-sufficient and become productive members of society.
These are just a few things I would do as part of the “repeal and replace” discussions surrounding the Affordable Care Act. I think it goes a long way toward helping our most vulnerable citizens, those temporarily down on their luck, while respecting the principles of federalism and encouraging personal responsibility and self-sufficiency. Now if you don’t mind, I’m going to go read my old Captain America and Wonder Woman comic books, because they can grasp the fact there is nothing cool about Nazis.
Abdul-Hakim Shabazz is an attorney, political commentator and publisher of IndyPolitics.org. You can email comments to him at abdul@indypolitics.org.
