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Last Updated: 9-22-09

Health Care Congressman Paul Ryan The call for fundamental health care reform has never been so loud and as necessary as it is right now. The third-party-payer model that serves as a framework for the financial underpinnings of our existing health care system no longer meets the needs of patients, doctors, hospitals, and governments. It has undermined the doctor-patient relationship and removed individuals from the decision-making process. Transforming America’s fractured and antiquated health care system demands wholesale and fundamental reform. Real reform requires a sincere and open discussion of these important questions. Unfortunately, Washington has failed in this respect –instead framing the debate as whether or not we are happy with the status quo.  H.R. 3200; America's Affordable Health Choices Act of 2009  At the center of this debate is H.R. 3200, America’s Affordable Health Choices Act. This legislation creates a new government-run insurance “option.” which advocates argue that only the creation of government-run insurance can facilitate “honest” competition among non-subsidized private plans. With all due respect, this is a dishonest argument. The public option is not designed to keep private insurance honest, but to make private insurance go away.  A new government-run plan would stack the deck against any would-be competitors. The private sector has to pay taxes; the government collects taxes. The private sector has to account for its employees and benefits, while maintaining minimum reserve requirements; the government does not. The private sector pays whatever rates it negotiates with providers; the government dictates payments.  Here is how it works: the government-run plan would reimburse doctors and hospitals at below market prices in order to control costs, similar to how Medicare underpays providers. When the government short-changes doctors and hospitals, the rest of us will be forced to make up the difference: those not on the government plan will have to pay more for the same care. If the government will only pay $70 to your doctor for a procedure that costs $100, then your doctor will charge you $130 for the same procedure to make up the difference.  With costs continuing to mount, employers will find it increasingly more cost-effective to dump their employees onto the government-run plan and pay an additional 8% payroll tax for each worker. Some estimates state that under a government-run plan option, 2 out of every 3 Americans would lose their current coverage within three years. The President has yet to reconcile this actuarial fact with his promise: “if you like what you got, you can keep it.”  As more and more people find themselves forced into the government-run plan, the only way to contain costs will be through rationing care by the federal government. The decision as to whether or not you receive a potentially life-saving treatment will not be a decision made by you, your family and your doctor. It is a decision the government will make for you.  That is why I offered a series of amendments when the House Ways and Means Committee held a 19 hour hearing on H.R. 3200 that would have addressed these issues. One of my proposals was to require that all Members of Congress enroll in the public plan. I believe if Congress is going to force millions of Americans into a government-run plan then their representatives should participate as well. Unfortunately, none of my proposals were accepted during this hearing. Despite this set back, it is my sincere hope that we can work together to bring about fiscally-responsible, patient-centered health care reform. With engaged participation from Wisconsinites in this critical debate, I believe that we can enact better solutions than those being rushed through Washington. We can – and we must – rise to meet the challenge before us.  H.R. 2520; The Patients’ Choice Act To meet this challenge, I have proposed an alternative approach to reforming our health care system. My bill, the Patients’ Choice Act, would put patients and doctors in control of health care decisions. It fundamentally changes the mechanics of Medicaid while strengthening the promise of health care and security for all Americans. Under my proposal, discriminatory tax rules would be reformed, ensuring that everyone gets the same tax benefits for the purchase of health care regardless of where they obtain that care. Every American receives an advanceable, refundable tax credit with which to purchase portable health insurance. We continue to encourage businesses to offer health insurance by allowing the current tax incentives for businesses to remain intact. So if you like what you have, you can keep it – but it will be your decision. Preventing Disease and Promoting Healthier Lifestyles.  Each year, five chronic diseases (heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes) cause two/thirds of American deaths; treatment of these largely preventable diseases makes up 75 percent of total health care expenditures. Critical investments in public health and disease prevention will go a long way in restraining health care costs and improving the quality of Americans’ lives. Creating Affordable and Accessible Health Insurance Options. Our health care system should be easier to navigate and provide integrated care in a more equitable manner. A vibrant market for health insurance that is consistent and fair will allow all Americans access to health coverage. The Patient’s Choice Act of 2009 would encourage states to establish rational and reasonable consumer protections, including the following: Creates State Health Insurance Exchanges to give Americans a one-stop marketplace to compare different health insurance policies and select the one that meets their unique needs Gives Americans the same standard health benefits as Members of Congress, so all Americans have a wide range of choices Protects the most vulnerable Americans to ensure that no individual would be turned down by a participating Exchange insurers based on age or health Creates a non-profit, independent board to risk adjust among participating insurance companies to penalize companies that “cherry pick” health patients and reward insurers that encourage prevention/wellness and cover patients with pre-existing conditions Helps States expand coverage through auto-enrollment at state and medical points of service, for individuals who do not select a plan at the beginning of the year Gives states the ability to band together in regional pooling arrangements, as well as the creation of robust high risk pools, reinsurance markets, or risk adjustment mechanisms to cover those deemed ‘uninsurable’ Equalizes the Tax Treatment of Health Care, Empowering All Americans with Real Access to Coverage. Economic analysts across the political divide agree that the tax code is stacked in favor of the wealthy and those who get their health coverage through their employers, discriminating against the self-employed, the unemployed, and small businesses. The Patients’ Choice Act of 2009 would restore fairness in the tax code and give every American, regardless of employment status, the ability to purchase health insurance by: Providing an advanceable and refundable tax credit of $2,300 per individual or $5,700 per family Improving the operation of Health Savings Accounts [HSAs] by allowing health insurance premiums to be paid with HSAs without a tax penalty Allowing preventative services to be covered by High Deductible Health Plans Increasing the amount of money an HSA owner may annually contribute to their account Modernizing the Medicaid Benefit and Protecting Medicare Beneficiary Choice. The health security for low-income families and American seniors is threatened by the outdated formulas and exploding costs of Medicaid and Medicare. These vital programs require significant reforms to better balance value for those beneficiaries in greatest need and protection for U.S. taxpayers. The Patients’ Choice Act would make important improvements to both programs without limiting eligibility or benefits by: Integrating low-income families with dependent children into higher‐quality private plans through direct assistance Removing the stigma of Medicaid and providing access to the same coverage options available to all Americans Realigning responsibility between federal and state governments in order to better coordinate benefits by requiring the Medicare program to assume Medicaid responsibility of premiums, cost-sharing, and deductibles for low-income seniors Rebalancing long-term care services to ensure choice between institutionalized and home-based care Empowering Medicare beneficiaries with more choices and more power by reforming Medicare Advantage Allowing for the creation of Medicare Accountable Care Organizations that would improve payment to physicians, hospitals, pharmacists, and nurses for demonstrable improvements in quality and patient satisfaction while reducing costs Requiring wealthy Medicare beneficiaries to contribute a little more for their care under Medicare Part D Establishing Transparency in Health Care Price and Quality. For a vibrant health care market to function properly, patients must know what services cost and who provides the best service. Uniform and reliable measures of reporting quality and price information should be designed by the stakeholders in health care rather than the heavy-hand of government. The Patients’ Choice Act would bring this much needed transparency into the health care market by: Empowering the private sector – rather than Washington bureaucrats – to set standards on price and quality with the input from all major stakeholders in health care, as well as the general public Ensuring that measures of effectiveness keep pace with innovation Additional Information. For more information on health care issues and priorities, please refer to the following web sites: Health Care Reform - A Plan Forward: http://www.house.gov/ryan/healthcare A Roadmap For America's Future: http://www.house.gov/ryan/roadmap www.americanroadmap.org Print