Friday, November 6, 2009

Hey Democrats, Pass Your Bill With Some Conservative Provisions

Tomorrow, the House of Representatives is scheduled to debate and possibly vote on H.R. 3962, the Affordable Health Care for America Act. Just three days ago, House Minority Leader John Boehner (Ohio) released the text of a proposed substitute amendment, which includes these well-known Republican provisions:

  • establishing association health plans and individual membership associations that can operate across state lines;

  • federal payments to states that achieve specified reductions in the number of uninsured individuals or in the premiums for small group or individually purchased policies;

  • federal funding for states to use for high-risk pools in the individual insurance market and reinsurance programs in the small group market;

  • enhancements to health savings accounts (HSAs) to allow funds in such accounts to be used to pay premiums under certain circumstances, to make net contributions to HSAs eligible for the saver’s tax credit, and to provide a 60-day grace period for medical expenses incurred prior to the establishment of an HSA;

  • limits on costs related to medical malpractice (“tort reform”), including capping noneconomic damages to $250,000 and punitive damages to $500,000 and making changes in the allocation of liability;

  • requirements to adopt and regularly update standards for electronic administrative transactions that enable electronic fund transfers, claims management processes, and verification of eligibility, among other administrative tasks;

  • establishment of an abbreviated approval pathway for follow-on biologics (biological products that are highly similar to or interchangeable with their brand-name counterparts); and

  • an increase in funding for HHS investigations into fraud and abuses.

With a 40 seat majority in the House, Democrats believe they do not need Republican support to pass H.R. 3962. Thus, the Boehner proposal is reduced to a political ploy intended more to influence future elections than to change H.R. 3962.

There is another alternative for the Democrats, which might not gain any votes but would at least begin to address the reasonable critiques that the Democratic health reform proposal does little to address right of center concerns.

Democrats should agree to as many of the Republican proposals as possible, beginning with medical malpractice reform and allowing enhancements to health savings accounts. Malpractice reform already has been passed in more than two dozen states.  Both malpractice reform and HSA changes will make minor differences in the overall federal budget but would remove at least a couple of thorns that bother health reform advocates.

After that, Democrats and Republicans might get together to address the cost and affordability issues, which so far still remain farfetched dreams rather than realistic (albeit painful) plans.


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