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The next best steps in health care repeal

January 23, 2011 - Mike Maneval
With the House passing a repeal of the health care reform act of 2010, the debate moves on to the U.S. Senate. And hopefully the leadership of the Senate can seize the opportunity the debate presents for real leadership, instead of passing an across-the-board repeal so all-encompassing it includes revoking measures - most notably the ban on using "pre-existing conditions" to deny coverage - the repeal's architects concede they support.

The first step the Senate could take is to consider legislation which only repeals the provisions within the reform act for which opposition has a broad consensus. The consumer mandate and the medical devices tax are the two elements I've most criticized from this blog, so it should surprise no readers that I feel these two provisions should be the frontrunners for repeal.

Advocates of the mandate have maintained requiring Americans to purchase health insurance is necessary, as other provisions of the act - put succinctly, the idea insurers should have to actually provide the services for which they accept money - increase insurers' expenditures. I've quarrelled with this notion - which employs a rancid worldview of contempt for consumers - here before. But fortunately, I can spare readers a further rehashing of that argument.

Because Republicans have a rough approximation of a solution. Allowing the purchase of health insurance across state lines, with the codified condition that the residents of the 50 states retain their rights as consumers recognized and detailed by their respective state legislatures, would deliver greater numbers of consumers to offset the sudden financial "burden" insurers face.

Some have argued the solution of consumers purchasing insurance policies across state lines carries a risk. The risk is that insurers will over time relocate to the states that allow them to charge policyholders the highest premiums while offering the least and lowest-quality of services. But this is a concern addressed easily enough. Through some approximation of the consumers' rights language to which I just referred, Pennsylvania's voters would not lose their rights to governance and to set minimal expectations as to what health insurance includes.

Whether or not Republicans - who after campaigning on "repeal and replace" voted on repeal in the House without any proposals to replace the reform act of 2010 anywhere near the floor - would continue to endorse permitting consumers to purchase insurance across state lines if the measure better protected consumer rights is uncertain. But the Democrats running the Senate can give them a chance to demonstrate their rough approximation of a solution is a sincere effort to bring more competition to health insurance markets - not an attempt to force states to compete to see who can let insurers take the most from consumers while delivering the least.


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