Gary Palmer, candidate in Alabama's 6th Congressional District, has a number of ideas concerning healthcare. Among the changes he wants to help enact is the repeal and replacement of the Affordable Care Act (ACA) with a market-based plan that will give Americans more control over their health care decisions and spending. The proposed plan will streamline the administration of physician practices and help restore the physician-patient relationship.
Palmer, campaigning for the seat currently held by Spencer Bachus, says the plan is among other plans being discussed in Washington now and will be a fraction of the cost of what the ACA will cost over the next 10 years. “The Republicans in the House have offered plans for replacing the ACA but have been blocked by the Democrat-controlled Senate. The Republicans need a majority in the Senate to pass a plan,” he says.
Palmer points out that because of the ACA legislation, about five million people have had their health insurance plans cancelled. “Based on what I am hearing about the impact of rising premiums, millions more are going to see their health care costs rise,” he says. “It also has been reported that thousands of families will see their plans cancelled prior to Election Day. And don’t forget, we spent $two billion setting up the ACA enrollment system.”
Under one of the Republican plans that Palmer discussed, a person would have the option of getting an employer-provided plan or purchasing a personal plan. The employer plan will be portable so if the person leaves that company, he can take the plan with him. Personal plans could be purchased across state lines so the person can shop for the best value and purchase what he needs, wants, and can afford. A tax credit of up to $1,400 per person will be available, and that money would either go to pay for a personal health insurance plan or be deposited into a health savings account (HSA). The plan would expand the use of health care savings accounts which would actually be a savings account that could be used to pay for routine health care. Any money in the account that is not used will roll over year after year.
“The plan would create an incentive for people to make better decisions about how they spend their health care dollars. It will help them lower health care costs and also gives them the incentive to live a healthier lifestyle,” Palmer adds. “There also will be certain limited opportunities for people to use the money for non-health care purchases, such as part of a down payment on a first home or for helping to pay for their children’s college expenses. What I would like to see happen is for people to allow the money to roll over each year so that when they reach retirement age, they will have a savings plan to use for long-term care insurance or to supplement their Medicare.”
For those who can’t get insurance or who can’t afford it, there will be a national safety net funded by the federal government, possibly with some contributions from states. “The federal government would fund the safety net, and it will be block granted to the states,” Palmer say. “It won’t be a match like Medicaid.”
Use of this proposed plan will simplify the administrative processes currently in place for both physicians and patients. “For example, someone could have a major medical insurance plan with a deductible of, perhaps, $5,000. The employer or, in the case of a personal plan, the individual would then fund a HSA with $5,000, or less if the plan did not provide first-dollar coverage. They would then be issued a HSA debit card with $5,000 on it which could be used only for health care, including dental and vision care,” Palmer says. “The account could be set up as a debit card, and when the HSA is used up, the medical insurance plan would kick in.”
This process would allow people to manage their health care while re-establishing the doctor-patient relationship, Palmer adds. It also will substantially lower the physician’s administrative costs because the coverage is on a debit card, which makes it basically a cash transaction. “If I practiced medicine and had a choice of filling out reams of paper to justify a reimbursement from an insurance company or getting paid with a debit card, I would prefer the debit card,” he says.
Palmer feels strongly that continuing to cover pre-existing conditions is the right thing to do and should be part of this plan. “We’ve got to find a way to help insurance companies offset those costs, however. And I also believe that when someone has a major disease or has an accident and can’t work, the safety net should be used on a means-tested basis to cover their insurance premiums so the patient doesn’t have to pay the full brunt of the cost and the cost is not passed on to the insurance company,” he says.
Another component of Palmer’s plan is a serious reform of medical malpractice. “A big cost of medicine today is the over-prescribing of diagnostic procedures. That’s not necessarily because a procedure is going to improve the health outcome; it’s to protect the physician from a lawsuit” Palmer says.
Regulations being imposed on physicians also are burdensome and costly, specifically the regulations mandated by International Statistical Classification of Diseases Related to Health Problems (ICD). This medical classification list by the World Health Organizations allows more than 16,000 different diagnostic codes and permits the tracking of many new diseases. When ICD 10, the 10th revision of this code, takes effect on Oct. 1, 2015, physicians will have to use more than 63,000 codes. That number will increase to more than 90,000 if ICD 11 is implemented.
“Because of this code, the Department of Health and Human Services was notifying physician offices to tell them they might need to obtain a six-month line of credit. If they misdiagnose Medicaid or Medicare patients, it could be six months before the problem is resolved and the physician receives payment,” Palmer says.
Implementation of Palmer’s proposed plan could stimulate the overall U.S. economy, he points out. “If we repeal the Affordable Health Care Act and replace it with another plan such as this, we will see companies hiring again,” Palmer says. “Under the current plan, full-time employment is defined as 30 hours. As a result, companies are cutting employees’ hours to 29 and classifying them as part-time employees. By restoring full-time to 40 hours, we will see people hiring again.”
Palmer says replacing the ACA is critical for the U.S. health care system. “I’ve talked to a lot of doctors and I’m concerned that if we don’t do this, we are going to see a lot of doctors quit medicine,” he says. “That’s sad for professionals to get to a point in their careers where they don’t feel like they can practice what they trained for years to do.”