Small-Bill Proposal for Sensible Health-Care Reform
To make health insurance more accessible, affordable, and portable — without increasing government
control, jeopardizing the quality of care, or breaking the bank:
1. Cut costs by preventing runaway malpractice lawsuits. Relieve doctors from having to practice costly
defensive medicine, by capping noneconomic and punitive damages, while continuing to allow unlimited
economic damages to compensate for financial loss. (No increase in government spending. Savings: $53
billion to the federal government, and billions in additional savings to private citizens.*)
2. Cut costs by allowing Americans to buy insurance across state lines. Allow Americans to shop for coverage
from coast to coast — whether from lower-mandate states at lower prices, or from higher-mandate (additional-
coverage) states at higher prices. Allow plans bought in one state to be transported to another. (No increase in
government spending.*)
3. Cut costs by allowing lower premiums for healthier lifestyles. Federal regulations ban companies from
offering more than a 20 percent discount to those who eat and drink in moderation, exercise, or don’t smoke. Such
regulations handcuff private cost-cutting efforts and should be eliminated. (No increase in government spending.*)
4. Increase access to health insurance by ending the unfair tax on the uninsured (and self-insured), giving
them a tax-break similar to that which is already available to those with employer-provided insurance.
Provide refundable annual tax-credits of $2,500 per person or $5,000 per family — directly to the American
people, not to insurers. Leave employer-provided insurance, its tax-exempt status, and the rest of the tax code,
intact. (Increase in government spending: approximately $80 billion (for credits beyond taxes paid). Reduced
revenues: approximately $120 billion (for refunds of taxes paid).*)
5. Provide further help for those who are uninsured and have expensive preexisting conditions, by
increasing federal support for state-run or state-organized high-risk pools. Thirty-four states already have
pools to help those who can’t get affordable coverage because of expensive preexisting conditions. We should help
all 50 states to establish or organize such pools. (Increase in government spending: $100 billion.*) (See ** below.)
6. Convert some federal funds into block grants to states, and reallocate the savings resulting from reducing
the number of uninsured. Disproportionate Share Hospital (or DSH (“dish”)) payments reimburse hospitals for
treating the uninsured in emergency rooms. With fewer uninsured, some of these funds can be allocated more
efficiently, helping to fund the above proposals. Start the block grants at 75% of each state’s current federal DSH
funding level, reduce them by 5 percent annually until they reach 50% in year-6, and then index them to the consumer
price index minus one percentage point. (No increase in government spending. Savings: approximately $180 billion.*)
7. Implement additional reforms from the House Republican health bill. Adopt regulatory reforms in the
small group and non-group markets, standards for electronic administration, an abbreviated approval pathway for
follow-on biological products, and HSA reforms). (Increase in government spending: $0. Savings: $20 billion.*)
*Tallies are estimates for 2011 to 2020, based largely on
previously published Congressional Budget Office (CBO)
projections. Additionally, an estimated $50 billion would
be saved through associated effects on revenues and
outlays, based on CBO scoring of the House GOP bill.
**A federal survey cited by the CBO indicates that 1-1.5
million Americans are uninsured because of preexisting
conditions. Safely assuming twice that many (2-3 million),
each person would get $3,333-5,000, plus a tax credit of
$2,000, for a total of $5,333-$7,000 in yearly federal relief.
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