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H.R. 3000: A Post-Repeal Appeal

Cain proposed replacing “Obamacare” with H.R. 3000. What is this bill all about, and what might it mean if it’s turned into the new health care law?

Oddly enough, health care reform has emerged as the one thing that all GOP candidates have agreed on so far. As we all know, repealing the Affordable Care Act (ACA), or ‘Obamacare,’ has become a cornerstone of the GOP political campaign. During the latest round of televised Republican Presidential Debates at Oakland University in Michigan, moderator Maria Bartiromo pushed candidates towards specifics, asking what they would replace Obamacare with after repeal.

Answers varied only slightly across the board. There were lots of familiar, canned statements about “the doctor-patient relationship” and “creating value for the patient.” Some candidates’ responses revealed they are out of touch with specific policies: Jon Huntsman, despite setting up one of two functional insurance exchanges in the US, missed the boat by calling to harmonize medical records, which as a provision of the HITECH Act from the 2009 ARRA funding, has little to do with the ACA.

Other ideas were more novel. Ron Paul and Mitt Romney called for medical savings accounts to reintroduce a market dynamic to the health care marketplace. Newt Gingrich called for a new agency on brain science, citing the high costs associated with ‘brain issues’ from Alzheimer’s to Autism to mental illness. Most candidates mentioned defederalizing Medicaid spending and doing something about medical malpractice reform.

The man with the bold solution? Herman Cain, and this time without a mention of 9-9-9. Cain proposed enactment of the H.R.3000 bill that’s been sitting in committee since September. Because there was no time for details in the 30 seconds he was given, here is the scoop on the proposed bill and potential implications of turning this legislation into law.

H.R. 3000: A Bold Solution

H.R. 3000 is the “Empowering Patients First Act,” originally introduced in September by Congressman Tom Price, a Republican from Georgia and an orthopedic surgeon. In addition to repealing the ACA, the bill proposes a handful of changes:

  • Provides $300 million in block grants, allocated to the states at the Secretary’s discretion, to subsidize private insurance coverage based on risk-adjusted pools
  • Sets up a tax credit for low-income individuals who are eligible, in only those states who have set up the above high-risk pool
  • Allow individuals to have access to coverage through an Individual Membership Association (IMA). Essentially, this is an employer group provision that enables wellness incentives without actually mandating coverage
  • Introduces “Association Health Plans” as a way for small businesses and other organizations to leverage market power to make coverage affordable. AHPs act as an intermediary between individual consumers and insurance companies, and preempt state law
  • Implements comprehensive malpractice reform provisions, from capping malpractice awards at $250,000 for non-economic damages, to speeding up claims resolution and creating state tribunals through grants to address disputes
  • Creates incentives for the medical workforce, including awarding loans to medical students and loan forgiveness for primary care providers
  • Forms a Quality Health Care Coalition that protects providers of private health care from antitrust settlements when negotiating prices with health insurance plans

The Devil is in the Details

Of course, there are a lot more details. For those of you involved in the reform debates the first time around, you’ll remember how painful and drawn-out they were, with some provisions taking months to reach agreement on. That’s a sure sign that even with a Republican candidate ascending to the Presidency in 2012, H.R. 3000 will likely need some tweaking before it’s good policy.

Specifically, there are fewer quality provisions throughout the legislation, in everything from embedding quality into benefits exchanges through qualified health plans (QHP), or the Center for Medicare and Medicaid Innovation (which is working on spreading solutions for some high cost but low-profile conditions that Speaker Gingrich forgot to mention: diabetes, hypertension, and other chronic diseases in a rapidly aging Medicare population).

The takeaway is that these political debates reduce issues down to the bumper-sticker level. Replacing the Affordable Care Act may not be a bad idea given the state of the US economy and the desperate need for job creation. But the ACA is about much more than a mandate. It does not make sense to repeal non-partisan portions of the bill and then replace them with virtually the same things. This is exactly what H.R. 3000 seems likely to do with quality performance measures for providers. Other portions of Cain’s proposed solution seem downright problematic. The antitrust protection for provider groups is nonsensical given what we’ve seen happening in Massachusetts: market consolidation has been directly responsible for the state’s rising health care prices.

The only guarantee we have with health care is its central importance on the campaign trail going into 2012. Beneath the politics, thousands of us continue moving forward every day to advance quality improvement, patient centeredness and cost control in health care. Whether we stick with the ACA or wind up with H.R. 3000, we can all agree that reform is badly needed. Let’s just hope that in the case of the latter, we’re careful not to throw the baby out with the bathwater in the name of politics.

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