Senator Hatch’s health policy proposal
January 28, 2013 5 Comments
Senator Hatch has released a set of 5 health policy proposals that I want to acknowledge. I have been pretty harsh on Republicans for not offering clear legislative details of what they are for in health reform/policy. This list doesn’t even mention Obamacare and focuses instead on Medicare and Medicaid; all these ideas could all work alongside the ACA, and the ideas range from pretty good to bad, but at least he identified something that he is for. A brief rundown of 5 policy ideas:
- Bad. Raise the Medicare age. A bad policy that I have written is virtually inevitable because it sounds consequential.
- Not so good. Limit what private Medigap plans can cover. Essentially he is saying that many Medicare beneficiaries have too much private insurance, and he doesn’t want people to have first dollar cover for anything. Here is a brief report on out of pocket Medicare spending; this is not a particularly consequential policy, as the real costs are after deductibles and co-pays are met, and the problem with this approach is that it doesn’t distinguish good from bad spending.
- Good. Simplify Medicare cost sharing across Parts (A, B, D) and implement a catatstrophic out of pocket maximum. This is an excellent idea, and the deductible and co-pay structure across the hospital, physician and pharmaceutical “parts” of Medicare should be simplified. This seems to work a bit against item #2. I’d focus my efforts on idea #3.
- Good if part of a deal to move ahead on ACA. Competitive bidding in Medicare. This is the part where a Republican says Obamacare exchanges are terrible, but if we had them in Medicare it would be great! In fairness, there are some Dems who say the opposite. The obvious deal is as follows: for any state doing the Medicaid expansion/setting up an exchange, then we do true competitive bidding starting 2 years later and move to learn from/unify the exchanges. I have written how this might go even further if we got started down this path. And if we need this, we don’t need to wait 10 years to start (the least brave proposal ever).
- Need more information; withholding fire. Per capita caps/modified block granting of Medicaid. The details of this are the most important. In my book I propose federalizing the dual eligibles, and moving over time to buy low income Medicaid beneficiaries into private insurance bought on exchanges. I am opposed to the type of block granting contained in the House 2012 budget which is essentially saying to the states “tag, you’re it” but I can imagine supporting an approach that does Medicaid very differently from how we now do it. The key is understanding that Medicaid is essentially 3 programs, and then moving ahead in that policy reality, understanding that the 9.5 Million dual eligibles and the 5.5 Million long term disabled Medicaid beneficiaries are some of the most vulnerable citizens in our nation.
The most interesting thing to me is that Sen. Hatch’s proposal includes nothing on medical malpractice reform. Here is a letter to Sen. Hatch in October, 2009 from CBO on medmal reform outlining 10 year deficit reduction of $54 Billion (~$41 billion in direct cost reduction, mostly medmal premiums; $13 billion in higher tax receipts as private premiums reduce slightly). As ranking member of finance and someone who tended to pay attention to health policy, this used to be standard fare for him to always bring medmal up as the fix all panacea. Now he leaves out a proposal he asked CBO to score in 2009. That talking point seems to have disappeared from the Conservatives/Republican play book on health reform. When was the last time anyone heard a Republican talking about medmal reform?
update: Sen Hatch is ranking member of the Finance committee; he was chair of Judiciary in the past.