How to bring the public the fair healthcare they deserve

Senate Democrats are resurrecting President Joe Biden’s shortsighted Build Back Better bill after reaching an agreement with Sen. Joe Manchin (D-WV). The bill, besides raising taxes and greenlighting Green New Deal provisions, would expand government control over drug pricing in a misguided attempt to bring down healthcare costs. Though the public largely agrees that healthcare reform is needed, given the 31 million uninsured people and the cost of healthcare averaging over $12,500 per person in 2020, sadly, but unsurprisingly, Republicans are being entirely excluded from the negotiations.

We have real differences in how we want to address our problems, leading to oversimplified stereotypes that suggest Republicans insist on fiscally responsible, long-term solutions that will bring costs down, while Democrats will not risk increasing the number of uninsured people, even in the short term. As a result, this disagreement has led to an impasse.

Our policy divergence made headlines recently when a bill artificially capping the price of insulin was opposed by the majority of Republicans in the House. Republicans agree that insulin must be affordable, but price-fixing never works and will lead to higher insurance premiums and out-of-pocket costs for everyone as insurers make up for their financial losses elsewhere in the system. Instead of working with us on this issue, Democrats have decided to pursue healthcare reform unilaterally through budget reconciliation. But as I know well from my time on the House Budget Committee in 2016 during the failed “Repeal and Replace” debacle, meaningful healthcare reform must be bipartisan.

That is why I crafted a comprehensive plan that combines over 75 bipartisan proposals to salvage workable sections of the Affordable Care Act to expand insurance and healthcare options, protect those with preexisting conditions, lower costs, and increase the number of insured people.

My plan, the Fair Care Act, will put more dollars back into the public's pockets so they can make their own choices about what healthcare options work best for them and their families while dropping the number of uninsured people by about 35% , or roughly 14.6 million people.

Here’s how:

The act would expand the public's ability to choose their own coverage instead of being forced to buy from their employers. The unlimited tax exclusion for employer-sponsored insurance makes health insurance the single largest subsidy in our tax code. Employer-sponsored insurance tax provisions enable employers to control roughly $1 trillion in benefits, which could instead be provided in wages. This tax exclusion disproportionately benefits those with better jobs, and therefore, better insurance, because the health benefit is not taxed regardless of whether a company offers a very generous health benefit package or the bare minimum.

The act would also reduce the market’s reliance on employer-sponsored insurance by repealing the employer mandate, capping the tax exclusion at $10,200, for individual coverage, and $27,500, for family coverage, and creating one, modernized health savings account employers can contribute to and employees can be eligible for without purchasing a high-deductible health plan. This will give employees more control over their healthcare spending by allowing the insurance plan and health savings accounts to follow the employees should they change jobs, as well as expand qualified uses of health savings account funds to include direct primary care and premiums.

Next, the act would extend greater protections for those with preexisting conditions by codifying the ACA’s preexisting condition protections under the Health Insurance Portability and Accountability Act, while increasing the number of individuals insured through the ACA exchanges to mitigate risk and lower premiums. The Fair Care Act does this through increasing advanced premium tax credit eligibility to younger people to encourage them to purchase insurance while they are healthy, restoring the 5:1 ratio in which insurers can charge lower premiums for younger, healthier people, and establishing a national invisible high-risk pool reinsurance program that directly subsidizes coverage for those with preexisting conditions. These policies will increase individual market enrollment, promote insurer competition, and lower premiums.

Finally, the Fair Care Act would preserve Medicare and allows it to fulfill its original purpose of providing for seniors while promoting site-neutral payments for inpatient and outpatient services to increase access to treatments at less costly outpatient facilities and promoting solvency by eliminating Medicare eligibility for multimillionaires.

My bill would also make permanent some of the recent telehealth expansions from the COVID-19 pandemic that allow for remote care to reach more patients, which is critical in rural districts like mine.

I am confident that a bipartisan solution can be found to deliver real and lasting healthcare reform to the public. Regardless of the difficulties that have come before us, we must deliver the public the fair care they deserve. No one should go broke from a tragic accident or diagnosis. I am confident that through the Fair Care Act, we can support free market solutions that protect the most vulnerable among us.