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Rand Paul Delivers His Obamacare Replacement Plan

Rand Paul Delivers His Obamacare Replacement Plan

Paul wants a replacement plan in tact before the GOP repeals the law.

Sen. Rand Paul (R-KY) has delivered his plan to replace Obamacare. The GOP wants to repeal the law as soon as possible, but Paul has urged the party to wait until they have a proper replacement plan in place to activate. He also noted that President Donald Trump and House Speaker Paul Ryan (R-WI) agree with him. The Hill reported:

Paul’s plan includes a tax credit of up to $5,000 per person to use as part of a Health Savings Account to pay for medical care. That tax credit appears to be larger than those offered in other Republican healthcare plans.

The plan would abolish many of the central elements of ObamaCare, including the mandate that everyone has coverage. It would eliminate the minimum standards for which health services an insurance plan must cover, which Republicans argue would allow for cheaper, less comprehensive plans.

The plan will also “eliminate some of ObamaCare’s protections for people with pre-existing conditions.” Paul offered “a two-year period where people with pre-existing conditions could get coverage.” After the period runs out, those patients can keep the coverage “if they continuously maintained coverage.”

But Paul concentrated the most on Health Savings Accounts. His plan will eliminate “the maximum allowable annual contribution” so people can put as much money into the HSA as they want. He also removed the requirement that those with an HSA must enroll “in a high deductible health care plan.” That way those who use Medicare, VA, TRICARE, and IHS have to the option to establish their own HSA.

Paul’s plan allows people to use money in their HSA to purchase health insurance. People may also rollover their HSA account to a child, parent, grandparent, or spouse.

Earlier this week, Sen. Bill Cassidy (R-LA) and Sen. Susan Collins (R-ME) talked about their combined plan to replace Obamacare. This plan would leave the majority of the power to the states, letting each one decide “whether the want to keep ObamaCare.” The states that want Obamacare can keep the entire with “its subsidies, mandates and protections for people with pre-existing conditions.” Those that choose to opt out will have another plan to “provide a uniform tax credit linked to a health savings account to help people afford a basic, less comprehensive health insurance plan.”

Paul found their bill “lacking, mostly because it allows too much of Obamacare to potentially survive on the state level.” From Reason:

He says he believes ultimately the best way to deal with very sick people with pre-existing conditions will lie with Medicaid and the states who can “look for innovative ways” to provide necessary care without bankrupting the system.

As far as the process goes, Paul says he does not expect a real repeal vote for at least two weeks. In the meantime, he says he is “pushing hard” his bill, which he’s “sent to leaders in the House working on the issue, discussed it with leaders in the Senate.”

He’s “trying to emphasize that this bill has the potential to insure millions at cheaper cost than under Obamacare and has great ability to straighten out the mess in the individual markets.”


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Paul took some of Dr. Carson’s ideas.

Obviously, there must be more in it, more details, but allowing premiums to be paid from HSAs is good. Getting rid of mandated coverage add-ons is essential, so that’s good.

The phase out of pre-existing is essential. Otherwise, it’s not insurance and it will spiral as people wait to buy the day after a diagnosis.

And by all means, let’s not let the states keep Ocare. What a trainwreck!!!

I have a plan too:

Repeal and ad let the markets do the replacement.

    CloseTheFed in reply to Exiliado. | January 26, 2017 at 4:47 pm

    Except there is a role to the feds: to allow competition across state lines.

    that alone would be immensely helpful.

BabetheBeagle | January 26, 2017 at 3:45 pm

Want to see more on this! It looks like a great start. Medical care is cheaper if you can avoid insurance except for catastrophic policies. Right now we are paying lots of people to pay our bills for us, and it’s driving up costs.

Sorry Rand, but that’s just rearranging the deck chairs on the Titanic. I read his “plan” and it tinkers with insurance, but contains nothing which will reduce the cost of medical care. No tort reform…no revision of EMTALA to save ERs from being used as free clinics…nothing to prevent pregnant Mexican women from sneaking across the border to have their children…nothing to reduce the 10-12 years it takes to get a new drug approved by the FDA…didn’t abolish the “medical device tax” on granny’s wheelchair…didn’t eliminate the death panel…

For a “free-market” guy, you suck, Rand.

    CloseTheFed in reply to snopercod. | January 26, 2017 at 4:52 pm

    To Snopercod:

    Tort Reform is a state by state item. And frankly, it’s much bigger, because it would have to address how jury trials are conducted, and the trial lawyers in each state will move heaven, earth, and turn over every stone, to stop that.

    As far as EMTALA, you’re correct, but that can be done in step 2. Also, it could be addressed by deporting, deporting, deporting.

    The FDA would be a separate bill also, and I assume Peter Thiel – who is now pretty close to Trump – and who wants to end death (no joke) – will be pushing EXTREMELY hard on the FDA, because, as he says (assuming he knows and I have every reason to believe he does) – the FDA doesn’t even allow them to treat “aging” itself as a problem, much less death.

    So, I hear you, but if you can get 5 yards now, and 5 yards later, take the damn 5 yards.


      mariner in reply to CloseTheFed. | January 26, 2017 at 11:08 pm

      I’m NOT in favor of “tort reform”, because in practice all it does is cap damage awards.

      The problem with that is that real damages are often immensely costly. A million dollars sounds like a lot of money until you start paying medical bills with it.

    I think the whole system of pricing medical care need to be addressed. Because the government got hooks into to pricing services and paying for services by code, there is no room to negotiate prices or amount of care unless you can convince the providers and their insurance companies (and yes, I mean “their” companies) that sufficient revenues are in place to prevent any business risk. What we get are ridiculous prices that drive out the non-insured unless they pay regular astronomical prices. Those attached to an insurance company plan get discounts and Medicare and Medicaid payments to providers get discounted by 90%.

    Medical care costs could also be ameliorated by passing laws limiting malpractice damages and then there are the cost of administering privacy laws and the documenting and re-documenting of who the patient is, why they are receiving services and on and on with the questions re-asked by nurses aides at every shift change and before every procedure. Maddening and costly stuff.

    Cutbacks in unnecessary procedures is the only way to shoot down the ever-rising medical prices.

I want the central government OUT of…

1. health insurance, and

2. medical care

EXCEPT where either of those LEGITIMATELY entail interstate commerce, WHICH is a VEERY limited ambit actually.

The whole “pre-existing condition” situation has been bungled in a way that only government could bungle it.

The general scenario is not someone who believes himself to be healthy and who follows all the health fads, so reasons that he doesn’t need to shell out for insurance … until he receives a mystical sign that he’s about to have a problem, so he then gets some insurance and shortly thereafter sticks his new insurer with a major expense. Certainly, these people exist, but that doesn’t make them typical.

Far more common is a person who gets insurance through his employer with his first real job after school. The employer pays into it for a couple of decades without his filing a claim for so much as a blood test—in other words, pure profit for the insurer for many years—then, when he reaches a “certain age”, has, say, a heart attack. Insurance covers most of his costs, everyone’s happy. But now he’s stuck. If he changes jobs, his new insurer won’t want to touch him, because he has … yes indeed, the dreaded pre-existing condition. Even worse, the new employer will be reluctant to hire such an employee, for fear that if he has another heart attack it will cost them a terrifying amount of money. (It won’t, but the fear is enough to scare employers away, probably because in health care, nobody seems to have any idea what things will cost until after they happen and the bills start rolling in.)

It’s fairly clear that the fundamental problem was ever tying health insurance to employment. If not for that, we’d buy health insurance the same way we buy car or house insurance; the employer would have nothing to do with it. And neither would the government. No more “tax credits” … try paying your hospital bill with “tax credits” some time. A slippery scheme only an accountant could love.

Of course then we’d have to actually pay for our own insurance, rather than expect someone else to pay for it, and that wouldn’t be popular.

    ugottabekiddinme in reply to tom swift. | January 26, 2017 at 4:51 pm

    It’s fairly clear that the fundamental problem was ever tying health insurance to employment. If not for that, we’d buy health insurance the same way we buy car or house insurance; the employer would have nothing to do with it. And neither would the government.

    Absolutely right. Most people have no idea that how this whole debacle began: to get around wage controls during WWII, Congress passed a law to let employers increase the pay to employees by providing them with a “fringe” benefit of paying for their hospital insurance (the original Blues), while still allowing the employer a deduction for the cost as if it were wages, yet NOT taxing the value to the employee as compensation.

    To truly begin a new direction, Congress ought to take the issue of medical care and payment for it and completely divorce it from the employer/employee relationship and its concomitant tax regime. Whether employed, or self-employed, or even unemployed, people somehow pay for their own auto and homeowners’renters’ insurance, and other than states that mandate insurance as a condition to license a vehicle, the government has very little to do with it.

    Milhouse in reply to tom swift. | January 26, 2017 at 5:38 pm

    Yes, that whole debacle has to be fixed, and McCain (yes, McCain) had a good plan to fix it in 2008, but the preexisting conditions issue doesn’t have to wait for that, there’s an easier fix for now. Just dictate to insurers (yes, by regulatory fiat) that when someone is transferring in to their coverage and they’re determining whether a condition already exists they must not look at the status now but at the status when he first got insurance all those years ago. If the condition developed during a period when he was continually insured then they must accept him, as if he’d been with them the whole time. (I’m not sure if that’s clear. It should be.) This fixes the immediate problem, while leaving the underlying problem to be fixed another day.

    Twanger in reply to tom swift. | January 26, 2017 at 5:55 pm

    Well said Tom Swift.
    We were discussing this just yesterday.
    90% of the health-care costs of an individual come in the last 3 months of life.
    Currently, insurance companies want to dodge this bullet any way they can.

One thing that could help people out and not enrich the insurance companies any more than they are already is to allow an uninsured person to pay cash at the same rate as MediCare does for any procedure that they might need. There is the BS charge that insurance companies charge knowing that MediCare is not going to pay, and there are the actual payments that they get from MediCare. The difference is huge but most doctors and hospitals will not offer that option. I think in my area an MRI reimbursement from MediCare is about $200. Most of us would be happy to have that rate. The same goes for most surgery procedures. Open competition from any and all insurance companies across state lines would also drive down costs. Imagine if there were only one or two car companies in your state what the costs would be for an econobox!

    Ragspierre in reply to inspectorudy. | January 26, 2017 at 4:31 pm

    Insurance companies…before ObamaDoggle…did not make high rates of profit on their exposure.

    There were a raft of “co-opt” insurance companies who eschewed the idea of profit pretty much altogether in the last couple of decades who went belly-up.

    How could insurance companies prevent the uninsured from paying cash?

    I’m an “uninsured” person, and I pay cash. My civilian doc is delighted to take it, and charges less than government pays because he has far lower overhead.

      inspectorudy in reply to Ragspierre. | January 26, 2017 at 11:58 pm

      They cannot prevent people from paying cash but the rates they charge are based on before negotiated rates that all insurance companies get. Some hospitals will give a cash payer a good rate but if that person does not know what a good rate is then they are screwed.
      Boeing does the same thing with their airplanes. Their advertised price is not what any airline will ever pay but if you wanted a business jet from them you would pay a lot more than the airline would. But to Boeing, their cost is the same and so are the hospitals costs.

        Ragspierre in reply to inspectorudy. | January 27, 2017 at 3:23 pm

        Dude, you just don’t understand economics, pricing, or much of anything along the lines you’re opining.

        If you don’t think my price for a car is going to be VERY different than a fleet buyer’s price, you are just not sane.

    inspectorudy in reply to inspectorudy. | January 26, 2017 at 11:54 pm

    After posting my comment above about a cash-based system for health services I ran across this article in “Time” magazine. It says cash based hospitals are booming and are expected to grow rapidly.

buckeyeminuteman | January 26, 2017 at 4:25 pm

I had an HSA once with a private employer. I put money into it thinking I could use that to pay for my insurance. I found out I couldn’t shortly before deciding to leave the company. Then found out that I would forfeit any money that was left in the account on my last day. So I found a website that caters to HSA account holders and bought cases and cases of contact solution on my last day. Why on earth do we let people avoid paying income tax on the money they use to buy contact solution? HSAs are actually kinda ridiculous and I don’t want anything to do with another one.

    That is an FSA account, which completely different from an HSA.

    HSA’s aren’t the issue. I had an HSA and high deductible insurance plan for several years before Obamacare came along and killed my plan. It was AWESOME! I had a set amount transferred into the account every month that I could use for ANY medical bills. It was not through an employer so I didn’t have any worries about losing my investment and it helped lower my taxes by running all of my medical expenses through that account. If I could reopen an HSA I would just to have the money set aside for deductibles and minor health care visits.

      inspectorudy in reply to gmac124. | January 27, 2017 at 12:06 am

      Your setup was the way to go. I have had experience with different companies and if possible, always get your insurance, HSA’s and retirement accounts outside of the company. The company will pay for it but they cannot control it or use it as a bargaining chip later. Also if your company goes bankrupt, ask me how I know, you will not lose anything except your job. This is why mobility of health care insurance, retirement accounts, and savings plans is so important. This is also the first step into getting one’s employer from being the source of their insurance. As long as the company gets a big tax break for providing insurance they will lobby to keep doing it.

I was a hard a** on insurance, until my sister came down with Rheumatoid Arthritus. Her health insurance was interrupted when her employer passed away and the cost of RA treatment turned out to cost a small fortune. She’s retired but working with severe RA just to pay for her (subsidized) premiums of $300 a month for a high deductible plan. She has to do this until she turns 65 and goes on Medicare. If she had no insurance, because of her pre-existing cshe would have to live with it untreated.

I was a hard a** on insurance, until my sister came down with Rheumatoid Arthritus. Her health insurance was interrupted when her employer passed away and the cost of RA treatment turned out to cost a small fortune. She’s retired but working part time with severe RA just to pay for her (subsidized) premiums of $300 a month for a high deductible plan. She has to do this until she turns 65 and goes on Medicare. If she had no insurance, because of her pre-existing condition, she would have to live with it untreated.
I don’t know what the answer is, but I do know, when something like this happens, one’s attitude tends to blur and soften.

another old guy joke to go along with healthcare.

Dr. Geezer’s Clinic:
An old geezer became very bored in retirement and decided to open a medical clinic.
He put a sign up outside that said: “Dr. Geezer’s clinic. Get your treatment for $500, if not cured, get back $1,000.”
Doctor “Young,” who was positive that this old geezer didn’t know beans about medicine,
thought this would be a great opportunity to get $1,000. So he went to Dr. Geezer’s clinic.

Dr. Young: “Dr.Geezer, I have lost all taste in my mouth. Can you please help me?”
Dr. Geezer: “Nurse, please bring medicine from box 22 and put 3 drops in Dr. Young’s mouth.”
Dr. Young: Aaagh!! “This is Gasoline!”
Dr. Geezer: “Congratulations! You’ve got your taste back. That will be $500.”
Dr. Young gets annoyed and goes back after a couple of days figuring to recover his money.
Dr. Young: “I have lost my memory, I cannot remember anything.”
Dr. Geezer: “Nurse, please bring medicine from box 22 and put 3 drops in the patient’s mouth.”
Dr. Young: “Oh, no you don’t, – that is Gasoline!”
Dr. Geezer: “Congratulations! You’ve got your memory back. That will be $500.”

Dr. Young (after having lost $1000) leaves angrily and comes back after several more days.
Dr. Young: “My eyesight has become weak – I can hardly see anything!!!!”
Dr. Geezer: “Well, I don’t have any medicine for that so, “Here’s your $1000 back.” (giving him a $10 bill)
Dr.. Young: “But this is only $10!”
Dr. Geezer: “Congratulations! You got your vision back! That will be $500.
Moral of story — Just because you’re “Young” doesn’t mean that you can outsmart an “old Geezer”.
Remember: Don’t make old people mad.
We don’t like being old in the first place, so it doesn’t take much to tick us off!

You’ve already lost the battle when your starting position is the lefts requirement of “replace”