Six in 10 Americans see health care as "very important" to how they'll vote in this fall's midterm elections, according to a recent Pew Research Center poll.
Unfortunately for Republicans, Democrats have successfully cast themselves as the only party that cares about the issue. But the GOP has plenty of good health policy ideas -- ideas that would expand consumer choice, promote competition, and inject transparency into the system. The party will need to remind voters of them if they hope to retake control of Congress.
A market-oriented GOP vision for healthcare reform could start with an expansion of health savings accounts, which allow individuals to put away money pre-tax to cover out-of-pocket health costs.
Federal rules currently restrict use of these accounts. Patients can only open HSAs if they're enrolled in high-deductible health plans. Annual contributions are capped at $3,650 for individuals. And Medicare beneficiaries can't contribute to them at all.
These rules don't make sense. Republicans could propose making HSAs available to any patient who wants one and abolishing contribution limits.
Allowing more Americans to pay for medical expenses with pre-tax money would cut out-of-pocket costs overnight. It would also create an incentive for providers to compete on price -- and thereby put downward pressure on health spending.
In addition, Republicans could focus on rolling back the Affordable Care Act's misguided insurance market regulations. These rules have outlawed strategies insurers previously used to keep premiums and deductibles down.
For instance, the law limits how much insurers can charge younger, healthier patients relative to older, sicker ones. It also requires plans to cover a list of 10 essential health benefits, regardless of a patient's needs or preferences.
These regulations have increased the cost of coverage. Between 2013 -- just before the ACA's exchanges opened for business -- and 2019, the cost of individual coverage more than doubled.
Democrats have responded by offering more generous premium subsidies to people through the exchanges. They did so in 2021 and 2022 via the American Rescue Plan Act and have extended those subsidies through 2025 as part of the Inflation Reduction Act.
This approach simply throws good taxpayer money after bad to cover up the pernicious effects of Obamacare's regulations. Three-quarters of the new spending on these more generous subsidies has gone to people who had coverage before they came into being. A family of four helmed by a 60-year-old making eight times the poverty level -- $212,000 last year -- could qualify for a subsidy of more than $12,000.
These subsidies do nothing to bring the actual cost of coverage down -- or boost its quality or the number of choices available.
Expanding access to short-term health plans, which aren't subject to Obamacare's restrictions, would offer people a lower-cost alternative to exchange coverage. It would be even better to scrap Obamacare's cost-inflating mandates altogether.
Prescription drug reform is another area where Republicans can offer a superior approach.
Democrats have convinced many Americans that empowering Medicare to "negotiate" drug prices directly with pharmaceutical companies -- a key provision in the IRA -- is the way to go. But this new system of price controls was intended mainly to generate revenue for the government, not save money for individual patients.
Moreover, by slashing pharmaceutical revenues -- and adding new risks to the uncertain process of drug development -- the IRA will have a disastrous effect on medical innovation. According to economists at the University of Chicago, prescription drug price controls could reduce the number of new drugs developed by as many as 135 by 2039.
It would be wiser to crack down on tactics insurers and pharmacy benefit managers use to shift drug costs onto patients. Every year, drug companies provide massive rebates to PBMs and insurers on brand-name medicines -- $175 billion in 2019. PBMs and insurers typically keep most of these discounts for themselves. They use a portion of the savings to reduce overall premiums.
Republicans could mandate that insurance plans share these rebates directly with patients. This policy could save individuals millions of dollars at the pharmacy counter without sacrificing life-saving innovation.
Americans are desperate for reforms that make high-quality health care more affordable. Republicans have a chance to answer that call. They need to seize the opportunity while they can.
Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020).
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