There’s a conservative health care plan that could reduce costs and help Americans get better access to medical care. Marie Fishpaw, director of domestic policy studies at The Heritage Foundation, joins us to share what lawmakers would have to change, and how the plan would work. Read the transcript, posted below, or listen to the podcast.
We also cover these stories:
- Republicans on the House Intelligence Committee are calling on Rep. Adam Schiff, the California Democrat who chairs the committee currently, to step down from that position.
- The House of Representatives took a symbolic vote to condemn the president’s ban on transgender service members in the military.
- Eric Holder, former attorney general under President Barack Obama, went after the “Make America Great Again” slogan, saying America really wasn’t ever great.
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President Donald Trump: Deductibles are way too high. Obamacare is a disaster, so we’re going to be—and I said it yesterday, and I mean it 100 percent. I understand health care now especially very well. A lot of people don’t understand it. We are going to be, the Republicans, the party of great health care.
Kate Trinko: That was President Trump this week reigniting the health care discussion. However, there was media skepticism at his pivot to health care. CNN, for instance, headlined a piece, “Trump says GOP will be the party of health care but provides no plan.”
Joining us today is Marie Fishpaw, director of domestic policy studies at The Heritage Foundation. Marie has been working with other conservative groups for over a year on a conservative health care plan that would lower costs and help improve medical care. Marie, can you please tell us about your Health Care Choices Proposal plan and what it would change?
Marie Fishpaw: Absolutely. It’s definitely fake news that there is no such plan right now. Conservatives have been working with lawmakers and the president’s administration since 2017 when we saw the very disappointing failures in the Senate to fulfill a campaign promise to lower health care costs and improve choices by repealing and replacing Obamacare.
In the wake of that failure, conservatives and others across the country have gotten together and come up with a plan that we call the Health Care Choices Proposal. What we like about it is it answers Americans’ real concerns about their health care, the things they’ve been telling us that they’re afraid of, that they don’t like happening, and that they do want to happen.
The big results from it are that costs would go down. We have estimates showing that premiums would decline by about as much as one-third, in some cases, and that people would be able to pick the right plan that works for them, unlike under Obamacare where costs have skyrocketed and choices have really fallen.
People can’t see the doctors they want because networks have narrowed. People would really be able to start. We’d see those trends reverse, and we would see people having the care that they’d like to have.
Daniel Davis: How exactly would it do that? What steps would the government take?
Fishpaw: It’s a couple steps. Step one is we need to stop the failed entitlement spending scheme that we have under Obamacare. This is a really backward entitlement spending scheme where insurance companies literally get more tax dollars from you and from me every time they raise their prices. That has been exactly a recipe for what we have seen, which is costs have gone up, and value has gone down.
We’re going to get rid of that failed entitlement spending scheme and replace it with a approach that takes the money that’s currently going to insurance companies through tax credits or Medicaid expansion and send it in a grant to states.
States would have to do a couple things with that. They would have to make sure that everybody could access coverage of their choice and not just insurance. People would be able to use it for those products. States would have to make sure that vulnerable people, so this is people with pre-existing conditions and lower-income people, can access care. I’d be happy to get into more details about how that’s useful.
Trinko: What you’re basically saying is in a state that is chosen to expand Medicaid after Obamacare, instead of giving Medicaid to people who now qualify, they would give them health care through these other means, like they would have the money to spend it in a different way?
Fishpaw: That’s right. The money and the system would remain to some extent largely intact. What changes is what it’s spent on and who gets to spend it.
Right now, dollars are going to insurance companies, in this case. Those insurance companies can only offer very specifically and tightly defined plans that are huge, every bell and whistle under the sun. They have a lot of restrictions on the types of products that people might offer.
Instead of that approach, individuals would get to say if they qualify for a subsidy, they get to go buy the plan that they think is the right one for them.
That could include things like religious sharing ministries—which is where people get together and help each other pay their bills, they don’t go through a formal insurance company—and arrangements where people want to work directly with a doctor, not going through a middle man. A lot more options rather than what’s happened today, which is people have really, particularly on Medicaid, been put into substandard plans.
If you’re sick, this is the whole myth that the leftist is pushing, which is that they like to claim that Obamacare has been really great for sick people. The reality is, if you are very sick, and you’re on Medicaid, you’re not going to be able to see the doctors that you need in most cases because specialists and doctors don’t take Medicaid.
Davis: Does this get those patients out of situations where they’re paying for plans that literally have to cover everything and that are high-premium?
Fishpaw: It does a couple things. Because the emphasis is on choice and letting people choose what works for them, yes. If you want to use your subsidy, or if you want to access a plan that covers everything, you can do that. If you want something that’s arranged a bit differently where you might pay more through a higher deductible and a lot less in premiums, you can do that.
The point is if you like what you have right now, you’re not going to lose it. You’re just going to have a lot more options.
Trinko: So this wouldn’t affect people who are not currently on Medicaid or any other government plan, if this went through? Is that right?
Fishpaw: That’s right. This only impacts people who are currently on Obamacare, people who are on Obamacare’s version of Medicaid, so not traditional Medicaid.
If you’re aged, disabled, nothing changes to how you’re getting your health care. The people who would really be impacted are the people who work for small businesses. Maybe their employer’s insurance had gotten so expensive they can’t afford to offer it anymore, the self-employed. These are the people who’ve really been hurt under Obamacare, in addition to those who are sick and need to get specialist care.
Trinko: You mentioned that this would reduce costs by up to one-third.
Fishpaw: It would reduce costs of up to one-third. We have independent estimates from a group of estimators who are bipartisan who have taken a look at what the result on premiums would be. They would come down by one-third, and it would also do so, and that is what’s important, in ways that continue to make sure that people with pre-existing conditions can access to care. …
This is a plan that is building on things that we know are already succeeding. It’s not a mythical pie-in-the-sky idea.
Today under Obamacare, some states can get some relief from the mandates that have really resulted in driving up costs and reducing people’s choices.
We’ve seen seven states that have taken advantage of that relief, and Heritage Foundation scholars Doug Badger and Ed Haislmaier have looked into those states. It’s both red states and blue states. It’s not a partisan thing, it’s a thing that works.
It’s states that are diverting a bit of the money that currently goes to insurance companies, and instead are giving it to arrangements that help people who have high health care costs pay those costs without raising the costs on everybody else. The results of these changes have been really striking. In some states, premiums have gone down by as much as around 40 percent.
Trinko: Wow.
Fishpaw: Right? All using tools that protect people with pre-existing conditions. I keep coming back to that because it’s become hard to listen to people on the left claiming that anybody who doesn’t want big government wants people to suffer, particularly if they’re sick.
Trinko: And die.
Fishpaw: And die.
Trinko: I think Sanders was asking how many people would die under some conservative health care scenario the other day.
Fishpaw: Yeah, he’s made some comments like that. I think it’s incredibly unfair because I think Americans are … we are wealthy and compassionate people, and we take care of each other. We’re not arguing about people getting access to care. What we’re arguing about is what’s the right way to do it?
We’ve seen Obamacare fail. This is not a successful program. It did not achieve the goals it laid out to achieve. Premiums have more than doubled in four years, a long litany of things that haven’t gone right.
The left’s solution to this is to double down on all those failures and do more with what Sanders is calling Medicare for All, which really means outlaw any kind of private coverage arrangement and put everybody on a new government plan.
The left wants to replace Obamacare, too. They’re just doing it in a way that, I think, would lead to more pain and suffering, like we’ve seen under the last few years.
Davis: Yeah. So the plan you outlined, it really seems to hit the sweet spot. Trump has talked about protecting people with pre-existing conditions, and yet getting rid of Obamacare, rolling that back. Where’s the GOP stand on this plan?
Fishpaw: I’m going to answer that question, but … we have some pretty broad-based support outside the Beltway. I think that’s important because part of the things that failed last time in 2017 were very much Beltway-driven products.
This is a proposal where we started with 13 people who signed onto it this time last year. We’re now at almost 100, and these are leaders across the country, national think tanks, state think tanks. We have two governors who have endorsed our proposal.
We think the reason for that is that we have really listened to what people were telling us that they needed, what problems they needed to be solved.
When it comes to where’s the GOP on this, President Trump has called on Republicans to return to this issue. He knows it’s important to Americans. That’s something that they need to be figuring out, if they’re going to accept his challenge.
Trinko: Do you think it’s important that politicians should tackle this issue? Obviously, there’s a lot of people who would prefer not to touch health care again.
Fishpaw: Americans want Congress to deal with this issue. When you look at polls, health care polls as one of the top issues for people over, and over, and over again.
I think they’re right to be frustrated. Republicans were elected, I think, over a course of eight years to deal with this, and then they didn’t.
The real vacuum right now, if there’s a leadership vacuum among Republicans, the Democrats would love that with doubling down on more of the things that have given to the problems we have right now, and that’s Medicare for All.
I do think that politicians need to deal with it. The left has their answer, I don’t think it’s the right one. I don’t think this is something you can avoid dealing with if you’re an elected politician.
Davis: Yeah, some really interesting polls, which I know you’re aware of, but for our listeners, Medicare for All polls a lot better than the details of Medicare for All. When people hear about the details of what it is they like it a lot less.
It seems like Republicans have been scared for years now that the left will just hit them with this … Do you think the country might be a bit more to the right on health care than Republicans tend to think?
Fishpaw: That’s an interesting way of putting the question. I look at it a little bit differently, which is Americans over, and over, and over again have said they care about their health care. They tell us they care about a couple things.
They fear that someone they love or that they themselves might not be able to see a doctor when they needed if they have a pre-existing condition, or they might lose access to coverage. They also fear having their private plan taken away from them.
They hope for more choices, they hope for lower costs. Nobody has really decided on who to blame just yet. The left would like to blame too many big businesses.
I think what’s important for people who work on these issues to remember is that this is really a choice about, are you on the side of an insurance company, which is where Obamacare has been; are you on the government’s side, which is where Bernie Sanders wants us to be; or are you on people’s side?
That’s where this plan would be, which says that people, families, individuals can make good decisions about their health care, if they work with their doctors and they’re given the tools to do so.
Right now, everything in our government system works against that. Just an example on that, if you are, say, a lower-income person and you qualify, you have an employer-sponsored plan, maybe you work at Walmart, but your income is too low to afford that plan, what our government today has said is that you get to go beyond Medicaid, which we know lots of doctors don’t want to take that. It’s as if let’s just put you on this thing and say you’re taken care of, but you’re not taken care of.
What’s great about the plan that we were talking about, that the conservatives have been working on for so long, is that it would say, “We do trust you to be able to make a good decision. If you want to stick with what the government gave you, OK, but if you want out, if you want to pick something that works better for your family, you now have the ability to make that decision.”
I do think that’s one of the transformative aspects of this plan, and why the stakes could not be higher when we start thinking about the direction of health care for our country.
Trinko: OK. Thanks so much for joining us, Marie.
Fishpaw: You’re welcome.