FOR IMMEDIATE RELEASE: Washington, DC (December 9) — A new report by American Enterprise Institute (AEI) scholars and other contributors outlines an agenda for reforming health care. The authors—who include many former senior government officials who have worked at institutions ranging from the White House, the US Food and Drug Administration, Centers for Medicare & Medicaid Services, the Congressional Budget Office, to the Joint Economic Commission—propose to replace outdated, counterproductive federal policies with practical, market-based reforms to provide health care for all Americans at reasonable prices.
Despite the enactment of the Affordable Care Act (ACA), health care in the United States is still in bad shape. Rather than attempting to fix the problem with more regulation, the US health care system needs to improve various areas of health policy, including Medicare, Medicaid, and health insurance, and replace a system that has become much too centralized under the ACA.
Among the key points:
- Replacing the ACA: A replacement plan for the ACA should be built on a more decentralized approach than Obamacare. It should shift the ability to make choices back to the consumer and return oversight authority to the states. Employers should be free to organize health insurance offerings that are attractive to their workers. Americans without access to employer coverage should be given a refundable, age-adjusted tax credit that is roughly equal to the average tax break given to employers who provide health insurance plans. All Americans should be given continuous coverage protection in an ACA replacement plan. Persons with preexisting conditions would be protected from being charged more or denied coverage based on their health status, so long as they do not experience long breaks in insurance enrollment.
- Medicaid: As it stands, Medicaid has experienced rapid cost growth, despite providing less than adequate services to lower-income households. A fundamental problem within Medicaid is the split financial responsibility between states and the federal government. The federal government pays for about 60 percent of all state Medicaid spending, with no upper limit on its total cost. Medicaid reform must begin with changing how the federal government pays for its share of total cost. By splitting the program into two distinct subparts, one for able-bodied adults and their children, and the other for the disabled and the elderly, states would be given much more authority to manage the program without federal interference. The federal government should make fixed, per-capita payments to the states based on historical spending patterns for the two population groups.
- Medicare: Medicare’s rules for paying hospitals, physicians, and other service providers affect how care is delivered to all patients, not just Medicare enrollees. The program would improve if more emphasis was placed on market-based reforms and fewer regulations. A starting point should be the transformation of the program to a premium support model. Beneficiaries would be entitled to a fixed level of federal support for their insurance and would be given the opportunity to pick from competing insurance options, including the traditional program and private insurance plans.
- Health savings accounts (HSAs): HSAs should be a central component of health care in the US, because they provide strong incentives for consumers to seek the best value for their health care purchases.
The complete list of authors includes Joseph Antos (AEI), James C. Capretta (AEI; Ethics and Public Policy Center), Lanhee J. Chen (Standford University; Hoover Institution), Scott Gottlieb (AEI), Yuval Levin (Ethics and Public Policy Center; National Affairs), Thomas P. Miller (AEI), Ramesh Ponnuru (AEI; National Review), Avik Roy (Manhattan Institute; Forbes), Gail R. Wilensky (Project Hope), and David Wilson (Wilson Partners).
For interview requests, please contact Paige Tenkhoff at paige.tenkhoff@aei.org or 202.862.5904.
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