There’s a running joke in the health world that the term “conservative health policy” is an oxymoron. While this author disagrees with this judgment, see the American Action Forum’s extensive body of work on health care policy here – there is a kernel of truth in that. Conservative policymakers have struggled to articulate a unified, cohesive vision for American health care the same way the left has with single-payer health care. While recent right-wing “proposals” on health care have been lack of detail and imagination, the Republican Study Committee (RSC) just came out to plan because Medicare reform, the notorious third rail of American politics, deserves to be discussed in the larger political sphere.
The policy of the RSC plan seems to stem from a single principle: Medicare must become viable without major tax increases. To this end, the RSC plan promotes several important reforms. First, and perhaps most controversially, it would raise the Medicare eligibility age from 65 to 67. Citing increased life expectancy and a decrease in the worker-to-beneficiary ratio, the RSC’s proposal would align the Medicare eligibility age with the current Social Security eligibility age, then index it to life expectancy. of life.
The next major point of the RSC plan is to create a unified plan administered by the federal government (called the “Federal Plan”) that would provide all Medicare benefits in Parts A, B, and D. Seniors could still access stand-alone Part D plans. The Fed plan would then be listed on regional stock exchanges alongside Medicare Advantage (MA) plans and stand-alone Part D plans. premium support subsidies for beneficiaries, tailored to income and wealth, for both the Fed Plan and MA plans, but based on the cost of the Fed Plan to discourage MA plans from raising prices to receive more of grants. Another big part of this section is the merger of Medicare trust funds into a single fund that would pay premium support subsidies.
The RSC has also proposed to significantly reform Medigap, essentially requiring a flat coinsurance rate of 10% between the first $750 spent and the $7,500 catastrophic cap. Additionally, the RSC plan would apply the narrow, site-independent payment policy first enacted in 2015 to all Medicare program providers, reducing incentives for hospitals to acquire medical practices. Other policies include the elimination of Medicare reimbursement to hospitals for “bad debts” resulting from Medicare beneficiaries not paying their out-of-pocket costs, the elimination of incentive payments to hospitals under the Medicare Shared Savings and Graduate Medical Education (GME) Funding Reform that would shift GME funding from mandatory spending to discretionary spending to require more oversight. Hospitals won’t be big on that. Neither will insurers: The RSC plan would not only require insurers’ MA plans to compete with the Fed’s plan, it would also eliminate quality premiums for MA plans and allow seniors who choose to retain private health insurance on Part A to keep their social security benefits. This would ensure that at least some older, usually more expensive patients remain on private insurance rolls.
The RSC plan needs and deserves more analysis and attention from the curators. The CBC has come up with a serious plan to remedy the health insurance financing problem without politically (and, in the case of the RSC, ideologically) unpleasant tax hikes. The left is certainly take it seriously. Conservative politicians should do the same.
Chart Review: Comparison of Employer-Sponsored Insurance and the Affordable Care Act Market
Danielle Bartolotta, Health Care Policy Intern
Advocates of the Affordable Care Act (ACA) have touted gains in ACA plan participation in recent years, but to some diploma these gains came at the expense of participation in an employer-sponsored plan. Employer-sponsored insurance (ESI) plans collectively cover more than 155 million non-elderly people. The ACA health insurance market, meanwhile, has recently experienced rapid growth with nearly 17 million people taking out cover through this option in 2022, up from 14.9 million last year. As the graph below shows, the past decade has brought more noticeable changes to Marketplace premiums than to ESI premiums. In the market, the first years following implementation saw a substantial increase in premium price changes with an increase of 8%, 20% and 30% in 2016, 2017 and 2018, respectively. ESI premiums have not seen such extreme changes, with annual increases between 2 and 5%. From 2018 to 2019, Marketplace premiums leveled off and have since fallen, thanks in part to generous federal subsidies. Since ESI premiums were not offset by federal subsidies, they were likely more directly influenced by rising health care costs. Policy makers should consider how the large subsidization of market premiums may have made these plans artificially but unsustainably attractive, causing people to turn away from CSE.
Data sources: KFF analyzes of Market Referral bonuses and Annual Single premiums for employer-sponsored health insurance
*Data for 2022 employer-sponsored health insurance not available
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