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Principles Guiding Health Care Reform

Nancy PiotterVirginia’s General Assembly is wrapping up its 2016 session during which legislators were able to hold the line against Obamacare’s costly Medicaid Expansion. However, Virginians for Quality Healthcare (VQH) has lingering concerns about some of the language in House Bill 30/Senate Bill 30 (the Budget) that leaves the door open to Medicaid Expansion in future years. Reforming Medicaid should remain a priority because Medicaid enrollees suffer worse outcomes than similar patients without Medicaid, and its value to recipients is lower than the government’s costs of the program. The problems are well known, the solutions are evident, but the work required to fix Medicaid is hard.

MedicaidFortunately, Medicaid reform is also addressed in a number of proposals to replace Obamacare. In a new health care system, the states—not the federal government—should have the authority to regulate health care markets, and exercise greater flexibility in meeting the health care needs of their citizens.

This month’s VQH post outlines key aspects of health care reform that would not only replace Obamacare’s destructive policies, but also modernize and improve the pre-Obamacare health care system. Let’s start with “consumer-centered health care reform.” Simply stated, it is

… a plan that empowers consumers, promotes a competitive market, provides security, protects the most vulnerable, and preserves the integrity of the relationship between patients and their doctors without government interference.[1]
And what do reformers envision? Numerous think thanks and research organizations have developed new health care policy recommendations. For example, a report from the American Enterprise Institute promotes a set of reform policies derived from these five principles:[2]

Citizens, not government, should control healthcare.
Government subsidies should come in the form of defined contribution payments.
Move power and control from the federal government to individuals, families, and states.
Suppliers of medical services must have more freedom to innovate and provide better services to patients and consumers.
Reform must improve the federal fiscal outlook by reducing long-term health obligations.

(Wikipedia Image)
(Wikipedia Image)
The body of that report thoughtfully expands on each principle, providing actionable recommendations which the authors conclude would:

… improve the value of [medical] services for every segment of the US population. The guiding principle is patient-centered care, which ensures those providing services to patients are committed to finding ever more effective ways of keeping people healthy or restoring them to their full health so that as many people as possible can engage in pursuits that strengthen their families and give them fulfillment in life.[3]
Similarly, a blueprint from The Conservative Reform Network is based on four principles paired with policy proposals (summarized here) to modernize health care and give individuals more control over their health spending and choices:

Security and freedom through health insurance choices: Provide a refundable credit for individuals who are not offered health insurance at work.
Flexibility for states: Let states receive federal health funding in a single allotment.
Modernizing Medicare: Use the Medicare Advantage and Part D programs as a model for how long-term sustainability can be brought to Medicare.
Fostering Innovation: Significantly streamline the FDA drug-approval process at the federal level.[4]

What is Congress doing about health care reform? Contrary to criticisms that advocates of Obamacare repeal have not offered specific proposals for alternatives, work was begun by conservatives on Capitol Hill as early as 2009 (more on this later.) A very significant milestone occurred earlier this year when Congress passed and sent an Obamacare repeal bill to the President (who promptly vetoed it as expected.) The measure, “Restoring Americans’ Healthcare Freedom Reconciliation Act” would have:

Restricted the federal government from operating health care exchanges
Phased out funding for subsidies to help lower and middle-income individuals afford insurance through the health care exchanges
Eliminated tax penalties for individuals who do not purchase health insurance and employers with 50 or more employees who do not provide insurance plans
Eliminated taxes on medical devices and the so-called “Cadillac tax” on the most expensive health care plans
Phased out [Obamacare’s] expansion of Medicaid over a two-year period.[5]

U.S. Capitol (credit Keith Stanley [])
U.S. Capitol (credit Keith Stanley [])
Further, House Speaker Paul Ryan said this bill would have reduced the federal deficit by a half trillion dollars.
But most importantly, [its passage] clears the path to repealing [Obamacare] with a Republican president in 2017 and replacing it with a truly patient-centered health care system. We will not back down from this fight to defend the sanctity of life and make quality health care coverage achievable for all Americans.[6]
If Obamacare is repealed, will Congress be ready with viable replacement legislation? In a significant development, Speaker Ryan stood up six House Task Forces in early February to develop a “bold pro-growth agenda” by the end of May, and one of those six teams is addressing health care reform. In late February, the chairs of that task force issued a mission statement comprising the following goals:

Empower every American with the ability to gain accessto coverage that is affordable and portable.
Provide Americans with more choices, not mandates, so they have the freedom to pick plans and providers that best fit their unique health care needs.
Protect the quality of care for all patients—including those with pre-existing conditions.
Promote innovationto improve competition, harness the power of new technologies, lower prices, and foster better cures and treatments for patients.
Save Medicare and Medicaid to strengthen health care security for seniors and America’s most vulnerable.[7]

Two key members of the task force, Representatives Tom Price, M.D. (R-GA) and Fred Upton (R-MI), have been engaged since 2009 in developing health care reform legislation. Price’s bill is entitled the “Empowering Patients First Act” (H.R. 2300), while Upton’s is a bicameral bill entitled the “Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act.”[8] Hopefully, the best parts of each plan can be merged into a bill that will truly liberate Americans from the oppressive burden of Obamacare, reinstate individual choice, foster innovation and competition to drive down costs, and truly modernize the health care system for the 21st Century. The Nation is waiting for healing through “PatientCare,” and time is of the essence.

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Note: This article from Virginians for Quality Healthcare is the fifth in a monthly series on Obamacare, leading up to Election Day, November 8, 2016.

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[1] Turner, Grace-Marie, “Replacing Obamacare with Consumer-Centered Health Reforms” (2015.)

[2] American Enterprise Institute, “Improving Health and Health Care: An Agenda for Reform” Dec. 2015,

[3] Ibid, p. 64.

[4] Turner, op. cit.

[5] Summaries for the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015,

[6] Speaker Ryan Press Office, “For the First Time: Congress Will Send an Obamacare Repeal Bill to the President’s Desk, 6Jan2016.

[7] “Task Force on Health Care Reform Releases Mission Statement” 25Feb2016.

[8] Summary for Price’s bill at

and Summary for Upton’s bill

Nancy Piotter
About the Author

Nancy Piotter is a member of Virginians for Quality Healthcare, supporting its efforts to repeal and replace Obamacare, and to keep Virginia free from government-run healthcare. Nancy retired from a civilian career in the Department of Defense, in the field of political-military analysis. She holds an M.S. in National Security Studies, and resides in Fairfax Station.