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What Next for GOP Healthcare Plan?

The irony of all ironies. The GOP healthcare plan defeated by the GOP! And I’m glad, given all the well-documented problems with the bill.

The Congressional Budget Office or CBO estimated that 17 million to 24 million Americans would lose their health insurance under the GOP repeal and replace plan. I would have been on top of the list, because I am over 60 but not old enough for Medicare. My grandfather was a Marine in World War I. Both my parents and all of my uncles served in World War II. My grandparents on my mother’s side came to Ellis Island a century ago. I am a red-blooded, patriotic American. How dare they try to take away my health insurance.

See also: Is U.S. Healthcare Ready for ‘All Payer’?  

I get that the ACA has major issues and needs fixes. I, too, have several issues with the ACA, including the employer mandate and how small employers are charged premiums under the ACA. (See: “A Quiet ACA Waiver — and Needed Change,” from April 2014.) I am on board with healthcare reform but not when it’s done on the backs of small employers.

Americans do need sound options for affordable healthcare coverage based on their needs. I get it.

The American public is sick of this political nightmare. The GOP thinks they need to repeal Obamacare to get reelected. Hello, the American public was 56% to 17% against the GOP plan. It is time for a bipartisan approach to healthcare reform. 46 U.S. Democratic senators just signed a letter that they be open to bi-partisan discussions to improve and provide fixes to the ACA, as long as the outright repeal of the ACA is not part of the deal. President Trump also just stated he’d be very open to discussions with the Democrats. Where does it say in the Constitution that to pass a bill in Congress all the votes have to come from one political party?

In addition, several moderate GOP congressmen were not in favor of the bill. My congressman, Rodney Frelinghuysen (R-11th NJ District), and three other Republican congressman from the Garden State announced opposition to the GOP bill for the right reason. It would have hurt the poor, the elderly and working families in their districts. Their offices were flooded with constituents opposed to the plan, along with powerhouses like the AARP.

The bottom line and reality is healthcare costs are never going down. We have an aging population of baby boomers with a ton of health problems, now and coming up. One of the major problems with the ACA is that the costs cannot currently be sustained, and a major reason is that 45% of the millennials ages 18 to 30 have not signed up, even though the overwhelming majority voted for President Obama and the Democratic party.

We have the best healthcare in the world in the U.S. Hands down. However, it is terribly wasteful, inefficient and fragmented. We still rely basically on a fee-for-service system that results in unnecessary and even harmful medical care. (See: “Unnecessary Surgery: When Will It End?” from October 2015.)

The only way to a lasting bipartisan agreement is to find common ground one issue at a time:

–Start with the major premise of the ACA, that Americans cannot be denied coverage for a pre-existing condition. Check.

–Next, help small employers hurt by the ACA and rising premiums.

–There appears to be widespread agreement to allow small employers to ban together in risk pools similar to workers’ compensation.

–Chuck Schumer just indicated a willingness to give the 50 state healthcare commissioners more power and control over premiums in their state. Remember healthcare, like politics, is all local.

–Consider tort reform based on the use of documented medical protocols by medical professionals. Millions of unnecessary tests are performed every day due to medical providers’ fear of a potential malpractice claim.

–Pass a bill to help medical students with their tuition and student loans if they will help serve as primary care providers in poor or rural neighborhoods for a year or two.

See also: Healthcare: Asking the Wrong Question  

There are a ton of good ideas out there that we spend our healthcare dollars on, including prevention and wellness and not sick care.

The time for bipartisan reform is now.

How a GOP Congress Could Fix Obamacare

Republicans are primed to take over Congress. A new FiveThirtyEight.com projection gives the GOP a 60% chance of winning the Senate this fall. And, according to RealClearPolitics, there’s virtually no chance Democrats will take the House.

If the GOP succeeds, public displeasure with Obamacare may be why. A recent poll from Bankrate.com found that more than two-thirds of voters say that Obamacare will play a role in how they vote in the coming election. Nearly half said it would influence them “in a major way.”

Of course, the next Congress has little hope of repealing Obamacare outright. The president would just issue a veto. Overriding it — though technically possible — would be difficult with an intransigent Democrat minority.

A GOP majority should instead focus on incremental reforms with bipartisan support — like tax cuts, regulatory reforms and repeal of some of Obamacare’s most unpopular mandates. That’s the most effective way for lawmakers to move our health care system toward one that puts markets and patients at its center.

Step one? Repeal Obamacare’s medical-device tax. This 2.3% excise charge on all device sales is expected to collect $29 billion over the next decade, according to government data.

Device firms are compensating by cutting jobs. Stryker, for instance, has cut 5% of its workforce — about 1,000 people. Zimmer Holdings has chopped 450 jobs. In total, Obamacare’s device tax could kill 43,000 jobs, according to Diana Furchtgott-Roth, an economist at the Hudson Institute.

Getting rid of the tax is a no-brainer. In March 2013, 79 senators — including 34 Democrats — approved a non-binding resolution calling for its repeal. It’s time to make that vote binding.

Second, a GOP-controlled Congress should strengthen health savings accounts. These financial vehicles allow patients to stow away money tax-free for medical expenses. HSAs are typically coupled with high-deductible health insurance. Patients bear the cost of routine care, and coverage kicks in when needed, like in the event of a medical emergency.

HSAs give patients a financial incentive to avoid unnecessary medical expenses. Converting someone to HSA-based insurance drops her annual health expenses by an average of 17%.

This year, 17.4 million people are enrolled in HSA-eligible plans — a nearly 14% increase over 2013. Among large employers, 36% now offer HSA/high-deductible plans, up from 14% five years ago.

Annual HSA contributions are currently capped at $3,350 for an individual and $6,550 for a family. Congress should raise them to $6,250 and $12,500, respectively. And patients with HSA coverage through the exchanges should be eligible for a one-time, $1,000 refundable tax credit to be deposited directly into their account.

Third, the new Congress should reform medical malpractice. Frivolous lawsuits and the threat of baseless litigation are increasing health costs and degrading quality of care.

Excessive malpractice suits drive “defensive” medicine, in which doctors order unnecessary procedures and tests simply to shield against accusations of negligence. This practice costs the country an estimated $210 billion every year, according to PricewaterhouseCoopers. Injecting common sense into the medical tort system would bring down that bill.

Earlier this year, the House Energy and Commerce Committee passed a bill that restricted lawsuits against doctors by, among other things, limiting non-economic damage judgments to $250,000. It was effectively ignored once it moved out of committee. Republicans should dust it off and pass it.

Finally, the GOP should repeal Obamacare’s employer mandate, which slaps midsize and large companies with a fine if they don’t provide sufficiently “robust” health coverage to full-time employees.

The mandate is destroying jobs. Employers are holding off on hiring and ratcheting back workers’ hours to avoid additional insurance costs. A Gallup poll found that 85% of businesses are not looking to hire. Nearly half cited rising healthcare costs.

There’s ample political support for repealing the employer mandate. The administration has already unilaterally — and maybe illegally — delayed its implementation. Several prominent backers have openly called for repeal.

All of these reform ideas are imminently actionable. They could find broad bipartisan backing and avoid a veto. Most importantly, they would move U.S. healthcare closer to a consumer-driven system, with patients empowered to control their own spending and market forces pushing costs down.