Republicans Propose a Bill with a Side of Tea

This week saw the re-emergence of Republicans in the healthcare debate. What effect does the GOP still have in the reform efforts in Congress?

On Tuesday the House Republican Caucus finally stepped forward with a plan released by House Minority Leader John Boehner (R-OH) as a healthcare reform alternative to the Democrat plan. Even though the proposal is moot given the dramatic House vote on Saturday, I thought it would be useful to consider their approach. It was clear from the outset of their announcement that with all of the traditional healthcare providers aligning with the House plan, the Republican bill was a day late and a couple of dollars short.

The Republican alternative would not raise taxes, remains deficit neutral and does not cut benefits for Medicare. Under the GOP plan, insurance companies would not be banned from denying coverage to those with pre-existing conditions, as they are in the Democratic proposal. Instead, additional federal funding would allow “high risk pools” to be established so those with such conditions could be provided subsidized insurance. Additionally, the Republican plan does not require people to purchase coverage nor does it mandate that employers offer insurance to their workers, key elements in the Democratic bill. We did our best this week to proactively compare the two bills. See the comparison to gain our assessment of the differences between the Republican and Democrat plans

Topic	Democrats	Republicans
Insurance Mandate	Requires all people to purchase healthcare insurance or face penalties	Does not contain a measure requiring people to purchase coverage
Employer Mandate	Requires companies with a payroll of $500,000 or more to offer health coverage, or pay a penalty of at least 2 percent of payroll. The penalty	Does not establish a mandate forcing employers to provide health insurance coverage
Medicaid	Bill expands Medicaid to 150 percent of the federal poverty level	Does not expand Medicaid or offer federal subsidies to low- and middle-income people to help purchase insurance
Medicare	The bill contains roughly $500 billion in growth reductions	Does not contain any cuts to the Medicare program.
Public Option	Public option includes negotiated rates and voluntary provider participation	Does not establish a public insurance option, instead focuses on expanding coverage by allowing purchase across state lines
Pre-Existing Conditions	Bill requires insurance companies to cover patients regardless of pre-existing conditions	Does not prohibit the denial of patients with pre-existing conditions, but offers $15 billion in funding to states to develop “high risk pools” to insure those who cannot afford coverage
Taxes	The bill creates a 5.4 percent surtax on married couples with incomes exceeding $1 million a year or individuals making more than $500,000 a year. The bill contains neither a “Cadillac” tax on expensive plans nor any additional industry fees.	Bill does not impose any new taxes
Selling of Insurance	Does not contain a measure allowing people to purchase across state lines, instead focusing on providing affordable coverage through a public option	Allows a consumer to purchase insurance across state lines while also allowing small businesses to band together and buy insurance together.
Tort Reform	Bill does not establish limits on “pain and suffering” damages	Bill establishes a $250,000 limit on noneconomic “pain and suffering” damages
Limit on Benefits	Prohibits insurance providers from creating annual or lifetime limits on coverage. Providers would be prohibited from canceling a patient’s policy if they become ill.	Like the Democratic proposal, the Republican plan prohibits insurance providers from creating annual or lifetime limits on coverage. Providers would be prohibited from canceling a patient’s policy if they become ill.
Cost	$829 billion over 10 years	$61 billion over 10 years
Deficit	Reduces federal deficit by $30 billion over 10 years	Reduces federal deficit $68 billion over 10 years
Expanding Coverage	Expands coverage to 36 million people	Expands coverage to 3 million people

Meanwhile, Congressman Michelle Bachmann (R-MN) made headlines for the Republicans this week by organizing a Capitol Hill rally on Thursday afternoon for those opposed to healthcare reform. Dubbed a “House Call,” Bachmann led several thousand conservative “tea party” protestors into the Capitol to confront Members of Congress who supported the Democratic healthcare plan. Armed with video cameras, the demonstrators confronted Representatives to create a video record of why they were supporting the healthcare reform efforts. But, Bachmann’s march through the halls of Congress Thursday signified much more than simple dislike for the Democratic healthcare reform plans. The protest illustrates the growing furor from the conservative wing of the conservative party that started last summer in hundreds of town hall meetings held throughout the nation. While healthcare reform will most likely pass through Congress and land on the President’s desk, Thursday once again showed that it won’t come without a fight

Kevin Fickenscher, MD

The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Perot Systems or its affiliates.

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November 09, 2009

An Update on the Report

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Election '09

Republicans Propose a Bill with a Side of Tea

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The Good, The Bad, and The Ugly