Serving the campus of the University of Alabama since 1894

The Crimson White

Serving the campus of the University of Alabama since 1894

The Crimson White

Serving the campus of the University of Alabama since 1894

The Crimson White

Expanding patient choice key to health care reform

An average of 140 million Americans shop at Walmart every week. Online retailers like Apple, Amazon and Google sold over one billion digital tracks in the first three quarters of this year.

Americans love markets, and they are always looking for the most convenient, affordable way to buy new products.

When it comes to health care, though, many Americans are rightfully concerned about putting lifesaving treatments up for sale on the open market. In a country as wealthy as the United States, no one should have to go without care because they cannot afford it.

Fortunately, we can harness the market to spur competition and innovation in our health care system and still protect our most vulnerable citizens.

Markets and smart government reforms can slow the rise of health care costs. Driving down costs will, in turn, make health care more affordable for more Americans and ease the strain public health care programs are placing on government budgets.

First, though, governmental policies that distort the health care market must be reformed.

One of the largest such distortions is the tax exclusion for employer-provided health insurance benefits. Currently, salaries and wages are subject to income taxes, while health benefits are not. This gives employers an incentive to supply and employees an incentive to demand health benefits as compensation.

Congress should change the tax code so health insurance benefits are treated as income. Health economists almost uniformly approve of this reform measure because it will decrease the over-consumption of health care and make health plan providers and consumers more conscious of the costs of their health coverage decisions.

This reform would also provide parity between those who currently receive health insurance from their employers tax-free and those, including many small business owners and workers, who buy coverage in the individual health insurance market with no tax benefits.

Congress should use the revenue generated by taxing health benefits to create a new, refundable health care tax credit available to all Americans, thus averting a net tax increase.

Taxpayers could use this credit to purchase catastrophic health insurance plans that safeguard against the “life or death” scenarios opponents of market-based health care reform fear, or they could apply the credit toward the purchase of a more comprehensive health insurance plan.

The credit could be means-tested to offer more help for lower-income workers. Additional help could come from Medicaid reforms that give states, which fund part of the program, more flexibility to control their own programs and hold costs down. Some states may decide to let beneficiaries choose how to spend their Medicaid dollars, allowing them to combine Medicaid subsidies with their tax credit to purchase their own health plan.

Reforming the tax code and Medicaid to give patients more choices will only be effective if there is a vibrant national health insurance market.

Currently, health insurance cannot be sold across state lines. The result is that Blue Cross Blue Shield controls 90 percent of the health insurance market in Alabama, depriving the market of competition.

This state-regulated scheme allows states to experiment with varying levels of health insurance regulation, but Congress could amend federal law to allow states to enter into voluntary compacts with one another that would permit health insurance to be sold between insurers and consumers in participating states.

These interstate health insurance plans could be structured according to the concerns of participating states.

Even with these reforms, a very small number of people with pre-existing conditions may be unable to attain health insurance in the individual market because their health risks are so high insurers can’t afford to cover them. For these Americans, the federal government should give states financial support for high-risks insurance or reinsurance pools that provide coverage at standard rates.

Federal regulations must also be reformed to make it easier for Americans with pre-existing conditions to transfer from job-based health plans to the individual market. This would make health insurance available to individuals with pre-existing conditions without requiring every American to buy a government-approved health insurance plan, as the Affordable Care Act, President Obama’s health reform law, will do.

The ACA attempts to compensate for the distortions the government has created in the health care market by leveling more regulations and spending more money on government health care programs. The reforms we propose would instead eliminate those distortions, reduce costs and target government resources to the most vulnerable patients.

We are confident the result would be a competitive health care market that can provide quality and affordable care and a strong, financially sustainable health care safety net for those who need it.

Ryan Sprinkle is a second-year JD candidate at The University of Alabama School of Law. Tray Smith is the online editor of The Crimson White. This column is the last in a three-part a series on health care reform.

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