Senator Mitch McConnell’s inability to cobble together a bill that 50 Republicans can support replacing ObamaCare reflects the diversity of health care needs, demographics, economic levels, and opinions on government’s role in the nation itself. One size does not fit all, particularly where health care is concerned.
The key to making this work is to let each state tailor the program to its own needs.
President Trump, Speaker Ryan, and Senator McConnell should unite on a four-part solution to the current imbroglio:
1. Leave it up to each state to decide its level of participation in the new health care system. Use the federal legislation to create a menu of options. Then pay the states the cash equivalent of the services and subsidies it is opting not to take under the federal program.
The need for a state-by-state approach is evidenced by how about half of the country opted to participate in the Medicaid expansion while the other stayed out (even with no federal payment of the cash equivalent).
2. Curb Medicaid Spending Through Co-Payments
The Medicaid program was conceived for poor people and any question of co- payments or deductibles was ruled out at the outset because of the poverty of the population being served. But now as Obama has expanded it into a lower- middle class entitlement (with people with incomes up to $85,000 eligible in some states), co-payments become feasible.
The use of emergency rooms has swelled under the Medicaid expansion, often rising by 50 percent or more. The ER has become the new community center where people can congregate out of the rain. Charging a $10 copayment at the door should reduce the utilization significantly, lowering the cost substantially with no social injustice.
3. Delete the List of Required Services
The reason CBO thinks so many people will be unable to afford insurance under the new bill is that it keeps the list of required services that must be offered under insurance plans to qualify for subsidy. 60-year-old men will still have to have maternity benefits. We will all have to have addiction treatment and mental health coverage. Again, one size has to fit all. Get rid of this requirement and let the states design individual packages that they feel best suit the needs of their citizens.
4. Expand the Number of Doctors
The fundamental problem with health care is that we are seeking to expand the utilization of medical and health services with no concomitant rise in the number of professionals who must deliver them. In fact, legal limits on the number of residencies nationally hold down the number of doctors at a time when we face a looming shortage of primary care physicians that will only get worse.
In short, use the Tenth Amendment to deal with this problem, like the Founders intended.
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