The Association of American Physicians and Surgeons (AAPS) has provided reform-minded Congressmen a one-page outline of ways to “increase options, encourage competition, and unwind unsustainable spending in American medicine.”
Americans need more choices, not fewer, AAPS states. The Affordable Care Act (ACA) prevents patients from choosing more affordable and desirable alternatives to the costly federal mandate-loaded ACA plans.
“Overregulation and mandates restrict access, stifle innovation, impede transparency, block competition, and raise costs,” AAPS writes.
AAPS also calls for removing barriers to Medicare and Medicaid patients seeking private options. “Citizens should be permitted to disenroll from Medicare Part A without forgoing Social Security payments. This would immediately decrease government spending and open the potential for a true insurance market for the over-65 population.”
Medicaid patients should also be allowed access to independent physicians, AAPS suggests. ACA requires physicians ordering and prescribing for Medicaid patients to be enrolled in Medicaid. This creates barriers for Medicaid patients who seek care from independent physicians but wish to use Medicaid benefits for prescriptions, diagnostics, and hospital fees. This is especially a problem for Medicaid patients seeking treatment for opioid addiction.
AAPS advocates seeking better options for addressing pre-existing conditions. ACA’s guaranteed issue/ community rating may sound attractive, but if prices are capped at what healthy patients will pay, the quality of coverage for sick patients plummets.
AAPS also asks Congress to:
• Explicitly define direct patient care (DPC) agreements as medical care, not insurance;
• Expand Health Savings Accounts (HSAs);
• End restrictions on health sharing ministries;
• End tax discrimination against individually owned insurance or out-of-pocket payment compared with payment through an employer-provided plan;
• Encourage indemnity insurance instead of plans with limited networks of physicians and facilities; and
• Encourage price transparency.
In a recent White Paper, AAPS writes: “American medicine is at a crossroads. It can continue on the path that leads from Medicare to ACA to a fully closed, coercive system, or it can allow freedom-loving Americans to build a private sphere with government confined to its constitutional role.”
Proposed solutions to increase options, encourage competition, and unwind unsustainable spending:
1. End regulations blocking alternatives to ACA, employment-based, Medicare, and Medicaid plans, while allowing those who wish to keep their current government plan to do so.
2. Encourage Price Transparency. Health care entities receiving taxpayer-subsidized funds from any source must disclose all prices that are accepted as payment in full for products and services furnished to individual consumers.
3. Decouple Social Security benefits from Medicare Part A. Citizens should be permitted to disenroll from Medicare Part A without forgoing Social Security payments. This would immediately decrease government spending and open the potential for a true insurance market for the over-65 population.
4. Repeal Medicaid rules that decrease Medicaid patients’ access to independent physicians. ACA requires physicians ordering and prescribing for Medicaid patients to be enrolled in Medicaid. This creates barriers for Medicaid patients who seek care from independent physicians but wish to use Medicaid benefits for prescriptions, diagnostics, and hospital fees. This is a particular problem for Medicaid patients seeking treatment for opioid addiction.
5. Explicitly define direct patient care (DPC) agreements as medical care (instead of insurance) so patients can use their HSAs, HRAs and FSAs for DPC.
6. Expand Health Savings Accounts (HSAs). (1) repeal the requirement that an individual making a tax deductible contribution to an HSA be covered by a high deductible health care plan; (2) allow members of a health care sharing ministry to participate in an HSA; (3) increase the maximum HSA contribution level; (4) allow Medicare eligible individuals to contribute to an HSA; (5) allow HSAs to be used to purchase health insurance; (5) fund HSAs through tax credits; (6) Roth-style HSAs.
7. End Restrictions on Health Sharing Ministries. Open the door for secular charitable sharing plans. Health Care Sharing Plans engage in voluntary sharing and are not a contractual transfer of risk.
8. End Tax Discrimination. Individual’s payments for premiums and medical care should not be taxed differently than payments made by employers.
9. Encourage indemnity insurance instead of plans with limited networks of physicians and facilities.
10. Increase options for addressing pre-existing conditions. Invigoration of competition, by implementing the above changes, would bring a variety of products for patients with pre-existing conditions and most importantly lower overall cost of care.
The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.
