Conservatives yet to rally around specific ACA reform proposal

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. Follow her on Facebook.

Guy Boulton

Guy Boulton

Guy Boulton, a veteran health reporter at the Milwaukee Journal Sentinel, took a look at some of the conservative health care policy proposals we’ll be hearing more about as the 2016 campaign gets underway.

Conservative critics of the Affordable Care Act, in and out of government, haven’t rallied around a specific replacement plan, or even a specific repair plan.

But Boulton notes that proposals by conservatives generally allow more flexibility in designing health plan benefit packages. Insurance might be cheaper for some people – but more expensive for others. And without standard requirements it might be harder for consumers to compare their options.

He notes that conservatives would like to eliminate or modify regulations that:

  • Cap how much health insurers can charge older people compared with younger people.
  • Require health plans to cover a package of basic benefits.
  • Set minimum actuarial values for health plans sold in the different tiers on the marketplaces set up under the law.

Boulton writes “No one has proposed ending the requirement that health plans cover people with pre-existing health problems. That provision, which also has increased premiums, is among the most popular changes in the law.” But, actually, some proposals would modify that key provision so that people who stay insured can’t lose their insurance because of a pre-existing condition, but if they have a gap in coverage they can lose that protection going forward for at least a time.

But eliminating key regulations, he notes, has a price. Lower premiums might mean higher deductibles, or the other way around. (That tradeoff occurs now in the exchange plans too. Slimmer benefit packages would cost less, although they provide less coverage.)

Those tradeoffs, choices and variety are a plus for people like Edmund Haislmaier, a senior research fellow of health policy studies at the Heritage Foundation.

“People have different preferences,” he said.

One challenge for the ACA is that many people are still not getting covered, citing affordability as the reason. For those who don’t get subsidies, health coverage can still be quite expensive.

If you want to read more about what some conservative policy experts (more at think tanks and academics than on the Hill at this point) a good place to start is Philip Klein’s book, “Overcoming Obamacare.”

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