CO REPUBLICANS PLAN FOR OVERTURN
Published online by San Luis Valley Health.org
By Colorado Public News
By Michael de Yoanna
The prospect of the U.S. Supreme Court throwing out the new health care law after it hears the case this month has Colorado Republicans planning alternatives – and Democrats keeping silent.
High Stakes for Coloradans
The stakes are high: Without the Patient Protection and Affordable Care Act, or any other major changes in health care, the average annual family health premium could hit $22,000 in the next seven years, according to an economic study called "The Future of Colorado Health Care."
Rising costs could make it harder for millions more Americans to afford care. As a result, even the most ardent opponents of the Democrats' 2010 health care law concede that rising costs would have to be addressed quickly.
To determine what might happen if the law is overturned, Colorado Public News asked all nine of Colorado's members of Congress to explain what they would do about two key health care problems cited by Americans in polls: the high cost of insurance, and the many people with pre-existing conditions unable to buy insurance at any price.
All four of the state's Republicans responded. Only one of the five Democrats did.
Spokespersons said the Democratic representatives and senators were either too busy or unavailable for an interview. The office of Democratic Sen. Michael Bennet issued a brief statement: "The health care law continues to make its way through the court system. Michael believes it will be upheld, and he will continue to work to bring down the cost of health care."
Colorado Public News also asked the White House, which did not respond.
Colorado's Republican members of Congress say they would seek to place limits on the role of government in providing care, and limit awards on medical malpractice lawsuits. Several also support more tax breaks for individual health insurance.
U.S. Rep. Doug Lamborn, (R-Colo), responds:
"If Republicans are able to pursue, like we have attempted on many occasions, free-market approaches to health care, we can bring costs down without heavy government intervention," said Congressman Doug Lamborn, of the state's 5th District.
"I think we desperately need health care reform," said Congressman Mike Coffman, a Republican for the state's 6th District. "But I think it needs to be away from the employer and toward the individual in terms of providing tax incentives and subsidies."
The Supreme Court Ruling
Starting March 26, the court will hear three days of arguments on the law. Justices could overturn the contentious requirement that individuals buy insurance or face a fine. The court may additionally rule that the entire health law is unconstitutional.
If that happens, popular provisions in the act would be scrapped, such as allowing young adults to remain on their parents' health insurance until age 26, and a 2013 requirement that insurers cover everyone, regardless of their health.
At issue is a requirement to buy health insurance or pay a fine. Without the millions of additional customers provided by a mandate, insurance companies say they can't afford to cover people with pre-existing medical conditions. The fine is needed to encourage people to buy; and to help cover the cost of government-provided health care when those who refuse to buy insurance turn up with a life-threatening crisis in a hospital.
Bob Semro, Bell Policy Center analyst:
Bob Semro, a health expert and research analyst for the progressive Bell Policy Center in Denver, said without the law there would likely be a worsening of existing trends:
Uninsured patients postponing care until a health problem becomes critical and much more expensive; and the looming prospect of people who are currently insured being priced out of the market in coming years.
Health insurance through a job costs the average family in Colorado $13,393 a year. That's about twice the cost compared with a decade ago, according to the state of Colorado's latest Annual Report of the Commissioner of Insurance.
Meanwhile, the state's four Republican representatives, all of them against the law dubbed by opponents "Obamacare," are eager to revisit the issue of health reform should the Supreme Court rescind the law.
U.S. Rep. Mike Coffman, (R-Colo):
Coffman said if that happens, he'd seek to resurrect a goal from the Obama law – the part that guarantees access to care to people with pre-existing conditions. "I do think the president's health care met that objective, but I think we could do it more cost-effectively."
Coffman added: "As we take care of people with pre-existing conditions, we've got to allow more choice for other people that is not envisioned in the health care law to have high deductible, much lower-cost policies, that people can afford as opposed to having policies with all the bells and whistles on them."
Several Republicans said the health care law is too expensive. They said its provisions to help 30 million Americans afford quality care could place too great a strain on the existing system.
"When third parties are in control of health care, people have every incentive to use it as much as they can," Lamborn said. "There's very little skin in the game whether you go to the doctor once a month or 10 times a month if it all costs the same. So when there's more personal involvement, yes, people will be maybe a little more judicious about using health care, but when they at least have some kind of stake in it, then I think it will be used more prudently by everyone instead of having people assuming other people are footing the bill."
U.S. Rep. Scott Tipton, (R-Colo), responds:
Rep. Scott Tipton, of Colorado's 3rd District, said he's spoken with older residents facing double-digit increases in their health care premiums despite the law. Some, he said, have been dropped from care. Stories like those are evidence to Tipton that the Democratic plan is not working.
"It is now the law of the land and medical costs are going up, so let's try a different model," Tipton said. "Let's let free markets actually work."
Health premiums continue to rise "at a faster pace than either inflation or wages," according to the state insurance report. However, much of the new law doesn't take effect until 2013, including the mandate to buy insurance, subsidies for those who can't afford it, easier access to nearly free care for the poor through Medicaid.
If the law is found unconstitutional, some Republicans want to create more tax credits for individuals.
"Right now there's a real inequity in that corporations can deduct the cost of corporate employees' health insurance," Lamborn said. "Individuals can't do that in most cases."
U.S. Rep. Cory Gardner, (R-Colo), responds:
One Republican idea is expansion of Health Savings Accounts. Currently in Colorado, Health Savings Accounts are provided only through employers, allowing workers to set aside pre-tax dollars for their premiums or medical expenses.
Other ideas voiced by Colorado Republicans include:
- Reducing the cost of care through supporting new technologies that increase access to care (Rep. Cory Gardner)
- Allowing individuals to buy insurance across state lines instead of requiring companies to meet varying state laws (Lamborn)
- Expand high risk pools for those who are considered otherwise uninsurable. (If individuals have no income at all, "it would be free," Lamborn said.)
- Make the delivery of Medicaid insurance for the poor "more cost-effective" or improve on it (Coffman, Tipton)
Another popular concept among Republicans is limiting awards for medical malpractice lawsuits. The idea could "rein in runaway spending and defensive medicine practices," said Rep. Cory Gardner, of Colorado's 4th District. Like Tipton, he also said that health care costs continue to rise despite the legislation.
But Coffman thinks placing limits on malpractice suits would have little traction with Democrats should the court scrap the law.
"What I think we need to do is come together in a bipartisan way and see what we can agree with," Coffman said.
But the probability of action this year by either party is poor given the current gridlock in Congress, according to people on both sides of the debate. And Lamborn said nothing may happen until after the election. Even then, he said, Republicans would have to sweep the elections, including the Senate – and perhaps even the White House – to get their way.