Mimsy Were the Borogoves

Editorials: Where I rant to the wall about politics. And sometimes the wall rants back.

Community health acts to improve Obamacare

Jerry Stratton, August 9, 2017

Parkview Hospital Emergency

For years, Republicans have campaigned on one thing: the insane damage that the Unaffordable Care Act is causing to health care. The insane prices that people who don’t get their coverage from employers have to pay for health coverage, due to Obamacare.

And they failed to pass reform, partly because they tried to pass a huge complicated mess that did not state clearly what the benefits were. Politicians were able to hide behind platitudes, ignoring the real issue: the ACA has vastly increased the cost of health coverage, and vastly reduced the quality.

Even Democrats in congress recognize just how expensive ACA plans have become, and freak out when it looks like they might have to follow the same rules we do when paying for it. They’re also now talking about bipartisan ways of fixing the mess that Obamacare created.

Here’s my suggestion: one page bills that clearly state the benefit of that particular provision. Make it very clear what the anti-reformers are voting against, and make it very easy for their opponents to hand out the exact text of what was voted against and say, this is what they were voting against. This isn’t a summary, this is literally the bill that they refused to pass.

“All it does is let you have the same benefits businesses do, all it does is give you choice, all it does is bring innovation, and my opponent refused to let you have that opportunity. Here, you can read the bill yourself. Yes, the actual bill.”

The personal health savings parity and portability act

The main reason that health coverage is not portable is that employer-provided coverage gets tax benefits that private coverage does not. When your employer docks your pay to pay for your health coverage, that comes out before taxes. When you pay for coverage out of pocket, it comes after taxes. That makes a big difference, big enough that it isn’t worth it for you to have portable coverage.1

This system is crazy. If you got the same tax break on coverage you want that you get on coverage your employer chooses for you, you might be more inclined to carry your custom coverage from job to job. I know very well I would have. I looked into it, but it made no economic sense due to the insane privileging of employers docking my pay to choose coverage for me.

The personal health savings parity and portability act would allow health savings accounts to cover temporary insurance, ACA insurance, health sharing organizations, and direct primary care—as well as any other form of health coverage. This would give private coverage a level playing field with employer coverage.

Further, the act would mandate that employers not be penalized in any way for allowing employees to forgo employer-provided coverage and get the difference in their paycheck.2

Employers wouldn’t be forced to drop coverage; but employees wouldn’t be forced to take employer-based coverage, either.3

Those who prefer portable coverage would be able to get portable coverage; those who have special needs not covered by one-size-fits-the-company-town employer coverage, would be able to get custom coverage.

And some of those who need custom coverage would be able to band together with others in the same boat, using health sharing organizations dedicated to their special needs, if the next suggested bill passed, too.

It’s hard to imagine this bill not passing, if it is kept simple and not turned into some sort of omnibus. Anyone who voted against it would have that fact used against them not just in the general but probably in the primary.

The voluntary community health sharing act

These are exactly what Democrats keep saying they want health care to be like. During the debate over replacing the ACA, I saw rank-and-file leftists “threatening” to create health sharing organizations if the replacement passed, unaware that such health sharing organizations already existed and Democrats had forbidden any new ones, including any new ones not built along religious lines.

The only reason I have any thing resembling health insurance4 now is because of health sharing ministries. But in order to join one now, you have to be Christian, because that’s what Democrats wrote into the law. At the time the law was passed, the only health sharing ministries that existed were Christian-based ones, and the ACA doesn’t let anyone else start a new one along different lines.

This is crazy.

The voluntary community health sharing act would allow new health sharing organizations to negate the ACA’s penalty for not having health insurance. It would allow them to be created along any line, not just religion lines. And, of course, it would allow them to be paid for out of health savings accounts to put them on parity with non-portable employer-based coverage.

Democrats in congress will vote against their rank-and-file and try to shut this bill down. But make them make the choice.

The laboratories of freedom act

One of the main constituents of conservative reform, allowing people to buy coverage across state lines so as to take advantage of innovations in other states, doesn’t make much sense under the ACA. The ACA’s one-size-fits-all mandates forbid states to innovate. California can’t show the world that single-payer works, and Texas can’t show the world that individual choice works.

The laboratories of freedom act would allow states to opt out of the ACA and try something innovative. For any state that opted out of the ACA, people in that state would also be allowed to purchase health coverage across state lines, so that if the state’s experiment turns out to be worse than Obamacare5 there’s a fallback for people in the state that isn’t any worse than the ACA because it is the ACA.6

Because Democrats (and beltway Republicans) prefer one-size-fits-all solutions, this bill is the least likely to pass. But all of these simple bills would show Americans where their politicians really stand, without the fig leaf of being able to say they oppose one obscure or even made-up part of an omnibus bill.

They would be simple, easy-to-understand bills that anyone could read. They’d be filibustered for that reason alone, probably, but, again, force the anti-reform representatives to filibuster them. That in itself would be real reform.

In response to Why we must not ration health care: Rationing health care means fewer cures.

  1. This is an example of why it’s a bad idea for government to nudge the marketplace with incentives. Seventy-four years ago a particular kind of health coverage got a tax break, and we’ve been stuck with that form of health coverage dominating the marketplace ever since. Who knows what innovations would have occurred in the last eight decades, if the government didn’t privilege that one form of health care coverage?

    The best solution would be to increase everyone’s exemption by the maximum health insurance deduction, and then not have a health insurance deduction. But despite this being a net gain for most people, it is probably politically impossible because the press would try to report it as either a giveaway to the rich (even though they would get the least tax break), a takeaway from the poor (even though it would vastly reduce the cost of health coverage and health care for everyone), or killing health insurance (even though it improves health coverage).

  2. This is not hypothetical: employers are willing to do this, or were willing to do it before the ACA began to go into effect.

  3. A strong case can be made for requiring federal employers to not provide health insurance. Government employee health insurance is often used as a shell game to hide the true wages of government employees. This would have the added benefit of helping to diversify the private market. And of course there should be nothing to stop federal employees from creating their own health sharing organizations.

  4. But they only resemble insurance. Health sharing organizations are not insurance, by design.

  5. I’m looking at you, California.

  6. As well as any other state-based innovations, but people would only choose another state if the state’s innovations turned out better than the ACA.

  1. <- ACA cuts off healthcare