Senators Coburn (R-OK) and Burr (R-NC) along with Congressmen Paul Ryan (R-WI) and Devin Nunes (R-CA)introduced the Republican's version of a healthcare reform plan called The Patient's Choice Act of 2009. I actually looked at the plan to see what type of ideas they were considering and found some amazing similarities to the Wyden-Bennett plan first introduced in the last Congressional term. Sam Stein provided a 14 page summary of the plan at the Huffington Post and in this diary I will refer to the pages of that summary from his post:
http://www.huffingtonpost.com/...
Prevention and Wellness:
First things first, both Republicans and Democrats agree that we need to turn our system from a sickness model to a wellness and prevention model. As such, the first concept that the GOP plan promotes is ways to promote prevention from chronic illnesses. They note that 5 preventiable chronic illnesses (heart disease, cancer, stroke, pulmonary disease and diabetes)cause two-thirds of American deaths and 75% of healthcare spending is on diseases that are largely preventable. So, they want the Center for Disease Control to coordinate a national strategy to promote prevention of these preventable chronic diseases. See page 3 and 4 to find out the different ways that they would promote wellness.
The Wyden-Bennett plan also promotes prevention but not in the detail that the GOP plan provides. It simply states that private health insurance companies have to provide wellness benefits that include disease prevention. See page 9 of this report on the Wyden-Bennett plan:
http://www.cbpp.org/...
The GOP plan just takes the Wyden-Bennet's plan to promote wellness to a new level with their involvement of the CDC in implementing a national strategy to promote wellness.
State Exchange Plans:
Second, starting on page 5 of the GOP healthcare plan, Coburn et al advocate that individuals should buy private health insurance through an exchange plan similiar to the Massachusett's connector plan. Each state would have to set up the Exchange. The Wyden-Bennett plan has the exact same provision. See page 9 of the above report.
Private health insurance offered through the Exchange would have to meet certain minimal benefit levels that would equal the health care benefits given to Congress. The Wyden-Bennett plan has a similiar provision. Under Wyden-Bennett, each private health insurance company would have to have the same healthcare benefits provided by the Blue Cross Blue Shield package under the Federal Employee Health Benefit (FEHB) plan. See page 9 of this report:
http://www.cbpp.org/...
The GOP plan would prohibit private health insurance companies from rejecting (cherry picking) customers with preexisting conditions or older customers. See page 5 of the report. Wyden-Bennett would outlaw insurance companies from charging different premium rates to people with preexisting conditions and/or older people. See page 9 of the report that I referred to earlier.
Taxing Employer-provided Healthcare Benefits:
Starting on page 6, the Coburn-Ryan plan talks about replacing the current employer-provided tax exclusion with an individual tax subsidy. The GOP plan would give a rebate of $2,200 for individuals and $5,700 for families so that they could purchase healthcare. Then on page 7, Coburn et al start promoting high deductible, catastrophic health plans with their favorite health savings account. They, in fact, want to expand high deductible health saving accounts to include concierge services and plans that would cover chronic illnesses.
The Wyden-Bennett plan also has a section on eliminating the exclusion of employer-provided healthcare benefits. However, their subsidy would be far more generous than the GOP plan. They set the subsidy for the individual at $6,025 and $15,210 for a family. See page 8 of the above cbpp report. The deduction would begin to phase out for individuals making over $62,500 and joint-filers making over $125,000. See page 8. This standard deduction would only go up with inflation. (Kind of a problem b/c historically healthcare costs have grown faster than inflation).
The Wyden-Bennett plan does not promote health savings accounts, but does say that they have to meet the same acturial value as the Blue Cross plan.
The GOP only barely mentions that wages would not decrease as a result of the exclusion of employer-provided healthcare benefits. The Wyden-Bennett plan says that it would eliminate the employer business deduction for providing health benefits to employees BUT they would still allow a business expense deduction if the employer provided higher wages to their employee to buy health insurance. See page 14. The GOP plan does not eliminate the business expense deduction for purchasing health insurance for their employees.
Changes in Medicaid:
The GOP plan calls for private insurers to replace Medicaid for certain Medicaid populations. In particular, on page 9, the GOP says that they want low income families with children to be enrolled in private health plans. The Wyden-Bennett plan would replace Medicaid and Schip with supplemental private health insurance. See pg 22 of the cbpp report.
Republicans would also provide more options when it comes to long-term care. On page 9, the GOP advocate more spending for home health workers instead of just nursing homes. The Wyden-Bennett plan is silent on long-term care. See page 31 of the cbpp report.
Third, Republicans would keep Medicaid for people with disabilities who require acute care. Again nothing in the Wyden-Bennett plan about this group.
Finally, I will discuss the major breaks from the GOP plan and the Wyden plan. The following parts of the GOP plan are not discussed in Wyden-Bennett:
Changes to Medicare:
The GOP wants to introduce competition to Medicare by allowing competitive bidding to set reimbursement rates. They would also increase payments to providers.
Tort Reform:
The GOP plan advocates health courts and an independent board of experts to examine evidence. Nothing new here. See pages 12-13.
Medical Records:
This section was completely new. I have never seen this idea brought up before that is on page 14. Basically, everyone would get a health card similiar to an atm card. The card would have your medical records and your insurance payment information. An independent board like a credit union would own the Independent Health Record bank accounts. Basically, they think that this concept would cut down on waste.
Conclusions:
Well, if the Senate has the intention of passing the Wyden-Bennett healthcare reform plan, then the Republican's announcement of the Coburn-Ryan plan brings us much closer to that objective.
Baucus a few weeks ago said that he wanted at least 70 votes for the passage of healthcare reform. With Wyden-Bennett, he could easily get 80 votes in my humble opinion.
Republicans already co-sponsoring Wyden-Bennett: Lamar Alexander, Bob Bennett, Mike Crapo, Lindsay Graham and Judd Gregg. I believe that Cornyn at one time was also a co-sponsor.
It's not that hard to see Snowe, Collins and McCain signing on, especially with Burr and Coburn advocating the GOP plan which is very similiar to the Wyden-Bennett plan. But we will see....