Comparing the party platforms on health care: Republicans

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo: Matt A.J. via Flickr

Photo: Matt A.J. via Flickr

Political party platforms get a spurt of attention in the summer of the respective party conventions – and then more or less disappear for four years.  But it is worth taking a look at the documents because they do sum up the mindset. Today we’ll start out with the Republican Party’s official take on a variety of health care issues.

The two party’s platforms’ actual language – choice of words, phrases and emphasis – is enlightening. The GOP’s document, for example, says of Obamacare: “It weighs like the dead hand of the past upon American medicine.”

The Medicare section is pretty consistent with GOP positions in Congress. It gives people a choice of “premium support” or traditional Medicare – an either/or that’s more politically palatable. The Medicaid block grant position also is consistent with long-time Republican orthodoxy, although right now the GOP-led Congress is looking at either block grants or a per-capita payment. The platform’s emphasis on Medicaid reform as a vehicle for addressing mental illness is new.

I’ve read elsewhere that the Republican platform opposes Medicare negotiation of prescription drug costs. My search of the document didn’t find that, although Congressional Republicans certainly do vigorously oppose that policy. On the campaign trail, Donald Trump has on a few occasions backed it – but so far it’s not on his campaign website’s health reform page.

Note: I omitted most references to abortion, stem cell research, conscience clauses, and family planning, except where it’s built into the health reform discussion. I also left out the sections on NIH funding, which both sides are advocating in Congress, and FDA restructuring. Check out the full GOP platform for those details. Here are some key sections from the document:

Restoring Patient Control and Preserving Quality

“Any honest agenda for improving healthcare must start with repeal of the dishonestly named Affordable Care Act of 2010: Obamacare. It weighs like the dead hand of the past upon American medicine. It imposed a Euro-style bureaucracy to manage its unworkable, budget-busting, conflicting provisions. It has driven up prices for all consumers. Their insurance premiums have dramatically increased while their deductibles have risen about eight times faster than wages in the last ten years. It drove up drug prices by levying a $27 billion tax on manufacturers and importers and, through mandated price cuts for drugs under Medicare and Medicaid, forced pharmaceutical companies to raise prices for everyone else. Its “silver plans,” the most common option on the government insurance exchanges, limit people’s access to their own doctor through narrow networks and restrict drug coverage, forcing many patients to pay for extremely costly medicines for their chronic diseases.

We agree with the four dissenting judges of the Supreme Court: “In our view, the entire Act before us is invalid in its entirety.” It must be removed and replaced with an approach based on genuine competition, patient choice, excellent care, wellness, and timely access to treatment. To that end, a Republican president, on the first day in office, will use legitimate waiver authority under the law to halt its advance and then, with the unanimous support of Congressional Republicans, will sign its repeal. The Supreme Court upheld Obamacare based on Congress’ power to tax. It is time to repeal Obamacare and give America a much-needed tax cut.

In its place we must combine what worked best in the past with changes needed for the future. We must recover the traditional patient-physician relationship based on mutual trust, informed consent, and confidentiality. To simplify the system for both patients and providers, we will reduce mandates and enable insurers and providers of care to increase healthcare options and contain costs. Our goal is to ensure that all Americans have improved access to affordable, high-quality healthcare, including those struggling with mental illness.

We will return to the states their historic role of regulating local insurance markets, limit federal requirements on both private insurance and Medicaid, and call on state officials to reconsider the costly medical mandates, imposed under their own laws, that price millions of low-income families out of the insurance market. To guarantee first-rate care for the needy, we propose to block grant Medicaid and other payments and to assist all patients, including those with pre-existing conditions, to obtain coverage in a robust consumer market. Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

To ensure vigorous competition in healthcare, and because cost-awareness is the best guard against over-utilization, we will promote price transparency so consumers can know the cost of treatments before they agree to them. We will empower individuals and small businesses to form purchasing pools in order to expand coverage to the uninsured. We believe that individuals with preexisting conditions who maintain continuous coverage should be protected from discrimination. We applaud the advance of technology in electronic medical records while affirming patient privacy and ownership of personal health information.

Consumer choice is the most powerful factor in healthcare reform. Today’s highly mobile workforce needs portability of insurance coverage that can go with them from job to job. The need to maintain coverage should not dictate where families have to live and work. We propose to end tax discrimination against the individual purchase of insurance and allow consumers to buy insurance across state lines. In light of that, we propose repealing the 1945 McCarran-Ferguson Act which protects insurance companies from anti-trust litigation. We look to the growth of Health Savings Accounts and Health Reimbursement Accounts that empower patients and advance choice in healthcare.

Our aging population must have access to safe and affordable care. Because most seniors desire to age at home, we will make homecare a priority in public policy and will implement programs to protect against elder abuse …”

Better Care and Lower Costs: Tort Reform

“Medical malpractice lawsuits have ballooned the cost of healthcare for everyone by forcing physicians to practice defensive medicine through tests and treatments which otherwise might be optional. Rural America is especially affected as obstetricians, surgeons, and other providers move to urban settings or retire in the face of escalating insurance premiums. Many Republican Governors have advanced the legal reforms necessary to reverse that trend. We support state and federal legislation to cap non-economic damages in medical malpractice lawsuits, thereby relieving conscientious providers of burdens that are not rightly theirs and addressing a serious cause of higher medical bills …”

Preserving Medicare and Medicaid

“… Medicare’s long-term debt is in the trillions, and it is funded by a workforce that is shrinking relative to the size of future beneficiaries. Obamacare worsened the situation — and imperiled seniors — by imposing hundreds of billions of dollars in cuts to Medicare providers to pay for its new spending. When a vital program is so clearly headed for a train wreck, it’s time to put it on a more secure track. That is why we propose these reforms: Impose no changes for persons 55 or older. Give others the option of traditional Medicare or transition to a premium-support model designed to strengthen patient choice, promote cost-saving competition among providers, and better guard against the fraud and abuse that now diverts billions of dollars every year away from patient care. Guarantee to every enrollee an income-adjusted contribution toward a plan of their choice, with catastrophic protection. Without disadvantaging present retirees or those nearing retirement, set a more realistic age for eligibility in light of today’s longer life span.

This is an agenda to improve healthcare, not just to manage its costs. We reject the Democrats’ approach of rationing inherent in Obamacare. We recognize the de facto rationing of healthcare caused by reduced access to doctors who increasingly opt out of participating in Medicare and Medicaid. We will not accept that or any other approach which denies care — or lowers its quality — for America’s elderly.”

Medicaid

As the dominant force in the health market with regard to long-term care, births, and persons with mental illness, it is the next frontier of welfare reform. It is simply too big and too flawed to be administered from Washington. Most of the vaunted expansion of health insurance coverage under Obamacare actually has been an unprecedented expansion of the Medicaid rolls in many states. We applaud the Republican governors and state legislators who have undertaken the hard work of modernizing Medicaid. We will give them a free hand to do so by block-granting the program without strings. Their initiatives — whether premium supports for purchasing insurance, refundable tax credits, alternatives to hospitalization for chronic patients, disease prevention activities, and other innovations — are the best strategy for preserving Medicaid for those who need it the most. Block granting Medicaid is particularly needed to address mental health care. Mental illness affects people from all walks of life, but there has been little success in developing effective system-wide medical models for addressing mental health. For a variety of unique reasons, government is often the first frontier for people experiencing mental health problems — from first responders who deal with crises to publicly funded mental health facilities and prisons where large numbers of inmates suffer from mental illnesses. Using block grants would allow states to experiment with different systems to address mental health and develop successful models to be replicated in states across the nation.

The current federally dictated mental health care regime is wasteful and ineffective, and moving to a block grant approach would allow for state and local governments to create solutions for individuals and families in desperate need of help in addressing mental illness. We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.”

Resources

  • The Republican platform’s health and education chapter: covers health reform, NIH, FDA, abortion and opioid issues
  • The platform’s government reform chapter: includes stands on Medicare and Medicaid
  • The entire GOP platform

One thought on “Comparing the party platforms on health care: Republicans

  1. Norman Bauman

    Gail Wilensky is on a short list of (relatively) rational Republican healthcare policymakers, especially when she writes in a peer-reviewed journal.

    http://www.nejm.org/doi/full/10.1056/NEJMp1610716
    Perspective
    What Would a Republican Win Mean for Health Policy?
    Gail R. Wilensky, Ph.D.
    September 14, 2016
    DOI: 10.1056/NEJMp1610716

    Significantly:

    “Unlike other Republicans, Trump has also proposed allowing drug importation and permitting Medicare to negotiate drug prices (though he hasn’t provided any details about what that would mean).”

    It’s hard to claim that you believe in a free market without allowing drug imports.

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