January 20 2017
The Senate committee hearing for Rep. Tom Price (R-Ga.), nominated to lead the Department of Health and Human Services, demonstrated some fundamental differences between the two major parties on health policy — differences that may have to be overcome or set aside if the Affordable Care Act will be replaced.
Democrats and Price “went around … a number of times,”a s Sen. Murphy said, on the difference between health insurance for all and “access to” health insurance for all.
Each time a Democratic Senator asked Price if he would work to guarantee the former, he answered back with a commitment to the latter.
But here’s the ugly truth: There’s really no such thing as universal coverage without coercion. Some people, given the choice, won’t buy insurance. That’s why Price and others frame it as “access” to health insurance.
We want all Americans to have the option and ability to buy health insurance, but we aren’t going to make them.
Therein lies the fundamental disagreement: Who makes what choices when it comes to health care? Price argued it should be the patient, while Democrats seemed to imply that without the federal government, patients would have limited choices, no choice, or would make poor choices for themselves.
For example: Sen. Sanders also criticized the idea of “access to” health insurance. “I have access to buying a 10 million-dollar home. I don’t have the money to do that,” he said.
Democrats and Republicans alike should acknowledge that high prices are a barrier to insurance coverage, even under the “Affordable” Care Act. Indeed, when uninsured Americans are asked why they don’t buy insurance, the number one response is that it’s simply not affordable, with 46 percent citing this reason.
It follows that, in order to increase the number of people buying insurance, the policy goal should be to decrease the price.
The ACA attempted to do this through a web of subsidies and tax credits, tied to income level. But the regulatory burden of the ACA has proven to be too much: Too many Americans have suffered harm in the form of cancelled plans, narrowed provider networks, and increased deductibles premiums —even for some people with subsidies.
A better approach would be to focus on lowering the pre-subsidy or “raw” price of insurance, the key factor in the equation.
Republicans expect that a freer market in health insurance would result in more affordable options, as insurers would offer more basic plans (like those available pre-ACA) again. And fewer mandates would not reduce choice, but would expand it.
Democrats unfairly charged that Price was not willing to share a specific plan to replace the ACA. These accusations seem misdirected at the congressman who has perhaps done more than any other Republican to work toward replacement.
Price has sponsored, every year since 2009, his comprehensive replacement plan, the Empowering Patients First Act. Democrats vacillated between saying there was no specific plan and criticizing Price’s, a confused line of attack.
Democrats make a few other charges, including the idea that without the ACA there would be no coverage for dependents up to age 26, and that there would be no mandated benefits, such as coverage for substance abuse disorders or birth control. But those claims completely ignore that state insurance commissions have jurisdiction in these areas.
Indeed, 37 states had mandates for dependent coverage (up to age 31 in New Jersey!) before the ACA. And all 50 states had some number of mandated benefits.
As Price said over and over again, no one — Republican or Democrat — wants to see Americans lose health coverage, face higher costs, or experience difficulty getting the care they need. With these goals, can it be so hard to find common ground?
Throughout the hearing Price said he hoped to “lower the temperature” in this heated debate in order to work toward shared goals when possible.
Let’s all hope that cooler heads prevail in the polarized and over-politicized discussion of what’s next for health reform.
As Chairman of the Committee Sen. Lamar Alexander emphasized in closing the hearing, we wouldn’t close one highway bridge before opening a new one, and Republicans similarly hope to transition away from the ACA in a responsible, thoughtful way.
Although confirmation hearing can tend toward political theatre, Americans are hopeful that both parties will focus on real solutions, despite our differences, in the months to come.