- Associated Press - Friday, January 20, 2017

PHOENIX (AP) - Arizona Gov. Doug Ducey is urging Congress not to repeal former President Barack Obama’s health care overhaul without a well-developed replacement plan, suggesting in a letter that it may take three years for a new system to be fully implemented.

In a letter and 15-page list of suggestions obtained by The Associated Press, Ducey urged House Marjory Leader Kevin McCarthy to eliminate many of the basic insurance requirements in Obama’s law and allow states to again set their own insurance rules.

Ducey is urging McCarthy to keep tax subsidies for individuals in place for now to keep the marketplace that now covers 180,000 Arizonans from melting down. And he wants state flexibility for Medicaid plans, including limiting coverage in lean times and to require healthy individuals to work or seek jobs to maintain their coverage. Those plans now cover nearly 2 million people, including 400,000 under Medicaid expansion that’s part of the Affordable Care Act.

McCarthy asked governors in early December for suggestions on how to the new Congress should repeal and replace the Affordable Care Act. Ducey’s letter and the larger list of suggestions from his top health staff was sent last week and provided to the AP under a public records request.

Here are some key points in Ducey’s letter:

OVERALL SUGGESTIONS

The Republican governor is a longtime critic of Obama’s law, saying in his letter that its “promises have proven false.” But he said that even with its many flaws, it is important to note that “there were flaws in the system we had before.” Individuals were prevented from getting insurance due to a pre-existing condition, for example, and for them, Ducey said “the thought of repeal and returning to a time when they could not buy insurance at all is very scary.” Ducey said any repeal law must include discussion of how to replace it and he doesn’t want to see “any Arizonans have the rug pulled out from under them.”

ELIMINATE TAXES

Ducey wants to repeal the taxes that pay for health insurance subsidies and other costs of Obama’s health care law. Ducey says those fees are just passed onto patients and states. He doesn’t explain how Congress should pay for continued costs of the law without those taxes.

INDIVIDUAL MARKET

Ducey wants the government to ensure there’s enough time to put in place a new health care plan before Obama’s law completely disappears, and he proposes doing that by maintaining subsidies to ensure people can maintain coverage while new plans are designed and offered by insurers. In addition, he wants allow new “healthcare sharing ministries,” faith-based cooperatives pool members money to pay medical costs but aren’t traditional insurance.

MEDICAID

Arizona has embraced the expansion of Medicaid, and Ducey negotiated with the Obama administration last year to enact program changes that allow some patients to be charged small co-pays for some services and require them to look for work. A lifetime 5-year limit and work requirement were rejected. Ducey hopes Congress goes a step farther by letting states place caps on enrollment, check for eligibility more frequently, impose work requirements and charge premiums and co-pays for coverage.

EMPLOYER MARKET

Ducey suggests allowing insurers and employers offer lower-cost plans if people quit smoking, lose weight or meet other incentive goals, saying participation in health goal plans alone won’t earn incentives. States should take over regulation of small business and employer plans, freeing them from minimum ACA requirements. Current tax deductions for employers that provide health insurance should be retained and extended to the self-employed.

REGULATION

Ducey wants states to take over insurance regulations now overseen by the federal government, allowing them to approve plans. He says essential health benefit requirements like payments for annual checkups and preventative care such as mammograms should be repealed so consumers could choose lower-cost plans. He also wants federal rules that keep older people from having to pay much, much more than younger people eliminated to lure younger people to buy insurance. He also said any changes should not increase uncompensated care, especially for rural hospitals.

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