On Wednesday, the nine justices of the United States Supreme Court will consider the case of King v. Burwell, concerning the constitutionality of Obamacare, determining the limits of President Obama’s executive power and the ability of the president to rewrite laws on his own while ignoring the constitutional duties of the legislative branch of government.
The court’s ruling would also impact the health care subsidies some citizens receive in Michigan and in 37 other states.
Before the Supreme Court issues an opinion, responsible state and federal leaders should construct a new health care model. A fresh approach to overhaul and remedy inequalities in America’s health care system is overdue. The Affordable Care Act, better known as Obamacare, has been an empty suit and did not live up to the president’s promises. Many Americans could not keep their health care plan, paid huge increases to stay on a plan, or could not keep their doctor.
Here is a prescription for health care options after Burwell:
First Principles: Any overhaul of health care should be patient-focused, consumer-driven and should favor the free market over a single-payer system or government-run bureaucracy. To paraphrase a popular ad, when companies compete, the consumer wins.
Eighteen-month “safe harbor” hold-harmless period: The potential Supreme Court ruling, concerning bedrock provisions of the U.S. Constitution and excessive use of presidential power, could cause stress for many individuals and families who may not be able to purchase insurance without the subsidies. A “safe harbor” provision for a 12- to 18-month period to help people who might lose subsidies would provide sufficient time for the president and Congress, as well as state legislatures, to enact a much-improved health care system that provides insurance to many who are uninsured, deals with pre-existing conditions, expands coverage and also lowers costs.
“You choose” option — opt-in, opt-out: Give Americans choice, the opportunity to choose their preferred health care plan. If you prefer Obamacare, then opt-in and keep it. But also guarantee Americans the freedom to purchase other health care options, separate from Obamacare. Former Sen. Phil Gramm refers to this as the “freedom option” and he is right. Choice is as American as apple pie, and the federal government ought not to be dictating what health insurance plan Americans cannot buy.
End Obamacare mandates and regulations: One example should suffice: repeal the medical device tax. Importantly, this is not just a Republican proposal. It enjoys broad, bipartisan support, including support from Democratic Sens. Al Franken, Elizabeth Warren and Amy Klobuchar.
End tax inequality: It is time to end a health care tax inequality that favors employer-provided health insurance while taxing millions who desire to buy insurance on the individual market. Continue to protect the tax treatment of job providers that offer health plans to their workers, and then extend tax credits to those who buy insurance on their own. The credits should be annual, age-adjusted and class-blind, available for a variety of health coverage options to make it easier for the uninsured to afford coverage.
Encourage the use of Health Savings Accounts: By providing access to Health Savings Accounts, consumers would have greater incentives to control costs and would be able to shop for the best health insurance plan that meets their needs. This can be encouraged through the use of one-time tax credits to get consumers started.
Allow interstate health plan purchases: End “lockout” provisions, which prevent consumers from purchasing health care insurance no matter where they live. Americans should be free to purchase health insurance anywhere in the nation. Portability of health care will increase competition and lower costs.
States make better decisions: The individual states should have broad opportunity to offer a diversity of health care insurance options to their citizens, including free-market options of premium subsidies, Health Savings Accounts and direct primary care options, as well as high-deductible plans coupled with other options. Medicaid recipients should be allowed to participate in any private market health plan.
Establish high-risk pools: Federally subsidized, state-managed high-risk pools should be used to cover the costs for those with high-cost health care needs.
Require insurers to cover adult children. Maintain the reform enabling adult children to retain coverage under the health insurance plan of their parents up to age 27.
Insure pre-existing conditions: No individuals should have his insurance canceled because of a pre-existing condition. All consumers should be given a transition period in which to purchase coverage so that no one is excluded because of his health history.
Some Washington elites are predicting gloom and doom should a majority of the U.S. Supreme Court justices rule against the Obama administration in King v. Burwell. In fact, just the opposite is true. The court case provides policymakers with a moment in time to offer real reforms that expand choice and competition, put the patient first and greatly improve options for health care coverage.
The Affordable Care Act violated the very first principle of medicine: Do no harm. This prescription is better for our health care system, and most importantly, for consumers. As with any prescription, if not administered immediately, the ailment only gets worse.
• Bill Schuette is attorney general of Michigan.