Here’s the Path Forward for Health Reform in 2018


Congressional leaders were poised last month to spend tens of billions of dollars in the omnibus bill to temporarily shore up Obamacare’s failing system.

Our plan recognizes that what works in Massachusetts will not work in Mississippi or Missouri or Montana.

Congressional Republicans are right to worry about Obamacare’s problems.

An open letter to the American public from over 30 conservative leaders, whose names are listed at the end.

Congressional leaders were poised last month to spend tens of billions of dollars in the omnibus bill to temporarily shore up Obamacare’s failing health insurance system.

That money, however, never would have given Americans the long-term relief they so desperately need.

After this idea was struck from the spending bill, Sen. Lamar Alexander, R-Tenn., who had worked closely with Sen. Susan Collins, R-Maine, to shape a bipartisan deal, said that “the only choice we have is to go back to repeal and replace the Affordable Care Act.”

We agree. Obamacare is broken and cannot be fixed, and there is a better way forward.

The True Cost of Obamacare

Soaring costs and declining choices are driving hardworking Americans and small businesses out of health insurance coverage. More than 28 million Americans remain uninsured. Millions more struggle to afford their premiums and deductibles.

Obamacare has nearly destroyed the private market for individual health insurance. Young people find it increasingly difficult to find entry-level jobs because the employer mandate makes it so expensive for companies to hire them. Lower-income Americans find themselves stuck with Medicaid rather than having a choice of a better plan.

The No. 1 issue voters want their elected representatives to address this year is the high cost of health coverage.

Give Americans Real Relief

Americans need genuine relief that doesn’t just paper over Obamacare’s serious flaws, but instead opens a new path for real reform.

We, along with many colleagues and allies in the conservative community, are working to chart this new path based on the reform plan offered last year by Sens. Lindsey Graham, R-S.C.; Bill Cassidy, R-La.; Ron Johnson, R-Wis.; and Dean Heller, R-Nev.

Our plan targets the two main problems under Obamacare: Costs went up, and choices went down.

To fix these problems, we lay out three big goals to: 1) lower costs and improve patient choices, 2) give states flexibility and resources to achieve these goals, and 3) set federal guardrails so people can choose private coverage if they don’t like the options their state provides.

Our plan recognizes that what works in Massachusetts will not work in Mississippi or Missouri or Montana. What works in big cities will not work in rural areas. In response, we would provide states with greater flexibility and new resources to serve as stewards in returning freedom and choice over health decisions to patients.

Dollars would flow not to insurance companies, but to the states through block grants that would replace Obamacare’s payments to insurers. With new flexibility, states could use the money to:

Lower premiums and stabilize turbulent health insurance markets.
Improve choices and encourage wider coverage for all by creating innovative coverage options.
Allow recipients to use their government assistance to buy a private health plan of their choice.
Protect the vulnerable by helping those with pre-existing conditions without making coverage so costly for the young and healthy.
Our plan would also support patient choice with improved health savings accounts. Taxpayers would be better protected because federal spending would be placed on a predictable path. And our plan has built-in life protections.

Building on Progress

This plan builds on stepping stones laid out by Congress and President Donald Trump.

Congress has repealed Obamacare’s most despised provision—the individual mandate tax penalty—starting next year. It also delayed several of Obamacare’s most destructive taxes, and it repealed the dreaded Independent Payment Advisory Board.

The Trump administration is doing all it can with its regulatory authority to give people more affordable choices, including allowing small businesses and individually-insured people the ability to join larger insurance pools to get better rates and more flexible benefits. And it is reviving temporary health insurance policies, which will allow millions of Americans a bridge to retaining coverage.

This step-by-step relief is important, but it is not enough. These actions do not repair the fundamental damage that Obamacare is doing to the private insurance market. For that, Congress must act.

Obamacare broke its core promises by increasing costs and reducing choices. The federal government has taken over decisions that should be made by families. Patient choice and competition have been usurped by government control.

There is a brighter path forward. Our plan would serve as a down payment to reverse this damage. It would begin to restore a properly functioning market in the health sector to lower costs through consumer choice and competition—allowing Americans greater ability to choose the doctor, health care, and health plan of their choice.

We believe this path could get majority support in Congress and show the American people that members understand their distress. We are inspired by the willingness of so many to work creatively toward providing this down payment solution to begin addressing Obamacare’s problems.

A Unique Solution

As former Pennsylvania Sen. Rick Santorum observed, in his 25 years in public life, this is the first time he has seen a major initiative emerge from “the bottom up and the inside out” to refine a policy proposal and build broad coalition support.

Congressional Republicans are right to worry about Obamacare’s problems. They would be wise to consider this plan as the true solution to the problems facing America under Obamacare.


Rick Santorum
Doug Badger, Galen Institute and The Heritage Foundation
George Barna, American Culture & Faith Institute
Gary Bauer, American Values
Naomi Lopez Bauman, Goldwater Institute
Lanhee Chen, Hoover Institution and Stanford University
Dean Clancy, HSAs for All
Benita Dodd, Georgia Public Policy Foundation
Marie Fishpaw, The Heritage Foundation
Linda Gorman, Independence Institute
Beverly Gossage, HSA Benefits Consulting and Independent Women’s Forum
Kristan Hawkins, Students for Life
Rea Hederman Jr., The Buckeye Institute
Phil Kerpen, American Commitment
Heather R. Higgins, Independent Women’s Voice
Dan Holler, Heritage Action for America
Lindsay Boyd Killen, Mackinac Center for Public Policy
Yuval Levin, Ethics and Public Policy Center
Carrie Lukas, Independent Women’s Forum
Nadine Maenza, Patriot Voices
Jenny Beth Martin, Tea Party Patriots Citizens Fund
Derek Monson, Sutherland Institute
Peter Morrow, Catholic Medical Association
Mike Needham, Heritage Action for America
Grover Norquist, Americans for Tax Reform
Sal Nuzzo, The James Madison Institute
Dan Perrin, HSA Coalition
Sally Pipes, Pacific Research Institute
Ramesh Ponnuru, American Enterprise Institute
Kevin Roberts, Texas Public Policy Foundation
Jameson Taylor, Mississippi Center for Public Policy
Mike Thompson, Thomas Jefferson Institute
Grace-Marie Turner, Galen Institute
Dan Weber, Association of Mature American Citizens

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With so much going on at the moment, I know it's been put on the back burner, but, they really need to do something about Obamacare and get rid of this nightmare. I had seen that they were working on things to replace it. Let's hope they focus on it again after the midterms. 

I apologize in advance.....I’m a real crepe-hanger on Obamacare.  All that stuff looks great on paper and may ever get votes from the public.  I seriously doubt they will ever have the votes in Congress to do a full repeal and replace. Those jacka$$ed candy-butts who stopped repeal and replace last year now own it.  Yep, Republicans now own Obamacare.  I have no respect for them. 

I agree with you, JG! 

This is what I am seeing on Healthcare! 

Your monthly premiums could be 20 percent lower if you buy the kind of short-term health plan the Trump administration is seeking to expand. But you won't necessarily get benefits such as maternity care or prescription drugs.

Yesterday was the deadline to comment on a proposal from the Department of Health and Human Services to let people buy these lean, short-term plans for a full year instead of just three months — and the agency got lots of mail from industry groups and medical associations urging it to modify or change its course.

If the administration finalizes the proposal — which could happen within the next few months — it will please conservatives who view it as a solution to expensive health plans under Obamacare. Because short-term plans are currently designed to basically tide people over during an unexpected coverage gap, such as a job loss, they’re exempt from the Affordable Care Act’s expansive coverage requirements.

But expanding the availability of these plans could also split the insurance market in two, siphoning healthier people into cheaper plans, while those who remain in ACA-compliant plans face premiums that spiral upward even faster, as my colleague Carolyn Y. Johnson explains here.

That’s precisely the concern being raised across the health-care stratosphere. The American Medical Association has warned it could “disrupt and destabilize the individual insurance market.” The American Academy of Family Physicians said it would allow insurers to avoid covering “vulnerable, expensive patients.” More than 100 patient groups have signed a letter in opposition.

View image on Twitter
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American Heart Advocacy
TODAY is the deadline to tell HHS not to extend short-term health plans.

The outcome is clear – Patients living with CVD, stroke survivors and others with pre-existing conditions will suffer if this rule becomes law. Add your voice:

12:01 PM - Apr 23, 2018
See American Heart Advocacy's other Tweets
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From the Crohn's and Colitis Foundation:

Crohn's & Colitis Fn

We are joining several other voluntary health organizations in urging the Administration to withdraw the proposed rule on short term health plans and notifying Congress of our concerns. See our coalition letter to Congress here:

9:42 AM - Apr 20, 2018
See Crohn's & Colitis Fn's other Tweets
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Even health insurers — who typically like more flexibility in the types of plans they can design and sell — aren’t fully on board with expanding short-term plans.

America’s Health Insurance Plans, the largest association representing health insurers, yesterday urged HHS to allow such plans to be purchased for just six months, not a full year, and ensure consumers are aware of what the plans don’t cover.

“We are concerned that this proposed rule will lead to more people being uninsured and under-insured, and to higher costs in the long run,” incoming AHIP president Matt Eyles said in a statement. “Short-term plans can provide an important temporary bridge for comprehensive coverage. But they are not a replacement for comprehensive coverage.”

The Blue Cross Blue Shield Association, whose members participate heavily in the Obamacare marketplaces, also said it has significant concerns that allowing consumers to stay on these plans for a full year “would cause rates to increase for those who need or want comprehensive health insurance coverage.”

Former Molina Healthcare CEO:

View image on Twitter
View image on Twitter

Mario Molina, MD
Hopefully, you had kids already, because under the short-term health plan expansion encouraged by an executive order signed last year, covered maternity care vanishes in 100% of plans analyzed by @KaiserFamFound.

Not angry yet? Get angry now. #SnakeOil …

10:23 AM - Apr 23, 2018
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Underscoring these objections, short-term policies are so lean that people who have them don’t even satisfy Obamacare’s requirement for having health-care coverage. Of course, that won’t matter starting next year, since Congress has canceled the penalty for being uninsured.

So what might these short-term plans cover — and not cover? It’s easy to get a sense because they’re already on the market. In an analysis released yesterday, Kaiser Family Foundation researchers looked at two dozen short-term plans sold in 45 states and the District through insurance brokers eHealth and Agile Health Insurance. A few of their findings:

The plans had premiums much lower than coverage on the ACA marketplaces, often 20 percent or less than the lowest-cost bronze plan offered in the same location.
Forty-three percent didn’t cover mental-health services, 62 percent didn’t cover substance abuse treatment, 71 percent didn’t cover outpatient prescription drugs and none covered maternity care.
Seven states — Alaska, California, Hawaii, Maryland, Montana, New Mexico and Utah — lacked any short-term plans covering services in those four benefit categories.
When plans did cover these benefits, limitations almost always applied that wouldn’t be permitted under ACA-compliant plans. Six of the seven plans offering prescription drug coverage capped the benefit.
“People who buy short-term policies today in order to reduce their monthly premiums take a risk that, if they do need medical care, they could be left with uncovered bills and/or find themselves “uninsurable” under such plans in the future,” the researchers wrote, although they also noted these patients could always buy more generous marketplace plans during the next enrollment period.





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