Republicans want to roll back Obamacare; Jeb knows how

Republicans have long vowed that Obamacare's days are numbered. Now they're finally getting serious about what they'll put in its place.

This month, former Florida Gov. Jeb Bush outlined a thoughtful replacement plan for Obamacare. His is the best Republican proposal to date.

Bush's plan aims to expand access to coverage and rein in health costs by reforming the tax treatment of health insurance and empowering patients to take greater control of their care.

He starts by pointing out that the Affordable Care Act has failed to, well, make care affordable. "One of the biggest flaws of Obamacare," Bush wrote on his website, "is that it resulted in skyrocketing health-care premiums across the country."

There's ample evidence to support him. Absent action, health costs are on track to consume more than half of the median family's income within the next decade.

Simply travel across the country to see the ACA's unaffordable impact. In Maryland, premiums for exchange plans sold by market-leading CareFirst BlueCross BlueShield will jump by more than 30 percent next year. BlueCross BlueShield exchange plans in Tennessee will feature premium hikes of more than 36 percent. New Mexico's top insurer, Health Care Service Corp., will raise prices by 51.6 percent.

These premium hikes are partly the result of Obamacare's benefits mandates, which require plans to cover everything from speech therapy to child dental care -- regardless of whether patients want them. Lower-cost plans covering only emergencies or medical catastrophes are largely forbidden by the ACA.

Obamacare has also made life difficult for small businesses. In making the case for his replacement plan, Bush argued that "it costs small businesses more to comply with Obamacare's myriad new rules than it does to insure a worker." According to a survey by the National Small Business Association, adhering to Obamacare's diktats costs the average small business more than $15,000 a year.

On top of that, the Obama administration is now fining small businesses that offer their workers money to help them pay for insurance or other out-of-pocket health-care expenses -- on the grounds that these "health-reimbursement arrangements" don't comply with Obamacare.

Beginning in July, small firms that gave their workers cash through HRAs have been subject to IRS fines of up to a $100 a day per employee -- or as much as $36,500 per person over the course of the year.

Never mind that small businesses are not legally required to offer coverage. In fact, under the IRS rule, they'd be better off not giving employees any help at all with their health care expenses.

Fortunately, Bush's proposal addresses the affordability concerns of individuals and businesses.

Bush would first roll back Obamacare's many cost-inflating coverage mandates. That would allow individuals and businesses to buy lower-cost catastrophic policies.

Individuals without employer-sponsored plans would receive tax credits to help offset the cost of coverage. Older Americans would receive larger credits, since they tend to have higher medical expenses and thus face higher premiums.

Small businesses would be allowed to give their workers tax-free lump sums to purchase coverage on the individual market.

Bush's plan would also leverage the power of transparency to reduce health care costs and improve outcomes. For instance, insurance plans would have to make simple information about their provider networks available before people signed up for coverage.

Empowering consumers and providers with information to make better health care decisions has the potential to reduce costs dramatically. According to the Institute of Medicine, our medical system wastes some $795 billion each year. Of that, $210 billion is the result of spending on unnecessary services, like repeated tests.

Such waste would decline if consumers took ownership of their care. The Bush plan encourages them to do so by nearly doubling the amount that they can set aside for routine healthcare expenses in tax-advantaged health savings accounts.

Patients will be far more vigilant about the cost of their care if they're the ones paying for it.

Technology can also make it easier for patients to control their care. For example, computer-assisted analysis of health-care data can nudge patients with high-cost conditions into disease-management programs that can lower costs and improve health.

The contrast between the Affordable Care Act and Bush's replacement plan couldn't be clearer. The former forces patients to pay ever-more for care; the latter empowers them to save money by making their own healthcare decisions.

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ABOUT THE WRITER

Joel White is the president of the Council for Affordable Health Coverage. He wrote this for The Philadelphia Inquirer.

This story was originally published November 10, 2015 at 12:00 AM with the headline "Republicans want to roll back Obamacare; Jeb knows how ."