Should Trump and the republicans adopt Rand Paul's plan? [Archive] - Debate Policy

jimnyc

04-03-2017, 01:03 PM

https://www.paul.senate.gov/imo/media/doc/ObamacareReplacementActSections.pdf

For others... the first portion is a blurb from Rand Paul's website... the second part is the entire text...

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Obamacare Replacement Act - Rand Paul
The Obamacare Replacement Act Sen. Rand Paul, M.D.
Since the passage of Obamacare, Americans have seen their premiums skyrocket, coverage they liked terminated, and dwindling choices of in-network healthcare providers. Many individuals who gained coverage through Obamacare are still, for all practical purposes, without insurance because the deductibles are beyond the reach of low income workers. It is essential that Obamacare be replaced with a plan that achieves what Obamacare failed to do - insure the most people possible at the lowest price.

Legalize Inexpensive Insurance Plans:

Obamacare not only told individuals that they must purchase insurance, but defined specifically what that insurance must be. The first order of business should be to ensure that Americans can purchase the health insurance coverage that fits their needs.
By imposing a variety of requirements on what plans can cover and how much they pay out in claims, Obamacare significantly increased premiums. By eliminating Obamacare’s essential health benefits requirement, and other restrictive coverage and plan requirements, low-cost insurance options will again be available to American consumers.
Help People Save To Buy Health Insurance:

Authorize a tax credit (up to $5,000 per taxpayer) for individuals and families that contribute to HSAs to further incentivize health savings.
Remove the maximum allowable annual contribution limit to HSAs, so that individuals may make unlimited contributions to an HSA.
Currently, HSA funds may not be used to purchase insurance or cover the cost of premiums. Allowing the use of HSA funds for insurance premiums will help make health coverage more affordable for American families.
Allowing HSA funds to be used for a broader range of health-related expenses give Americans the freedom to choose the type of health care they wish to receive. Eligible expenses are expanded to include prescription and OTC drugs, dietary supplements, weight loss programs and physical exercise expenses, and direct primary care and concierge medicine services, among others.
Fair Tax Treatment of Health Insurance

Equalize the tax treatment of the purchase of health insurance for individuals and employers, by allowing individuals to deduct the cost of their health insurance from their income and payroll taxes, they will be empowered to purchase insurance independent of employment.
Help Individuals Join Together to Purchase Insurance:

Expand Association Health Plans (AHPs) allow small business owners and individuals to band together across state lines through their membership in a trade or professional association to purchase health coverage for their families and employees at a lower cost.
In addition, we should allow individuals to pool together through any organization to purchase insurance.
These new pooling mechanisms increase the buying power of individuals and small businesses to decrease costs, increase administrative efficiencies, and protect individuals with pre-existing conditions by giving them access to the group market.
Allow the Purchase of Insurance Across State Lines

Increase access to health coverage by creating an interstate market for health insurance that allows insurers licensed to sell policies in one state to offer them to residents of any other state.
State Medicaid Flexibility

Provides states new flexibilities for Medicaid waivers for innovative state plan designs.

https://www.randpaul.com/news/obamacare-replacement-act-rand-paul

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The Obamacare Replacement Act (S. 222)
Sen. Rand Paul, M.D.
Repealing Obamacare
Ø Effective as of the date of enactment of this bill, the following provisions of Obamacare are
repealed:
o Individual and employer mandates, community rating restrictions, rate review, essential
health benefits requirement, medical loss ratio, and other insurance mandates.
Protecting Individuals with Pre-Existing Conditions
Ø Provides a two-year open-enrollment period under which individuals with pre-existing
conditions can obtain coverage.
Ø Restores HIPAA pre-existing conditions protections. Prior to Obamacare, HIPAA guaranteed
those within the group market could obtain continuous health coverage regardless of preexisting
conditions.
Equalize the Tax Treatment of Health Insurance
Ø Individuals who receive health insurance through an employer are able to exclude the premium
amount from their taxable income. However, this subsidy is unavailable for those that do not
receive their insurance through an employer but instead shop for insurance on the individual
market.
Ø Equalizes the tax treatment of the purchase of health insurance for individuals and employers. By
providing a universal deduction on both income and payroll taxes regardless of how an
individual obtains their health insurance, Americans will be empowered to purchase insurance
independent of employment. Furthermore, this provision does not interfere with employerprovided
coverage for Americans who prefer those plans.
Expansion of Health Savings Accounts
Ø Tax Credit for HSA Contributions
o Provides individuals the option of a tax credit of up to $5,000 per taxpayer for
contributions to an HSA. If an individual chooses not to accept the tax credit or
contributes in excess of $5,000, those contributions are still tax-preferred.
Ø Maximum Contribution Limit to HSA
o Removes the maximum allowable annual contribution, so that individuals may make
unlimited contributions to an HSA.
Ø Eliminates the requirement that a participant in an HSA be enrolled in a high deductible
health care plan
o Currently, in order to be eligible to establish and use an HSA, an individual must be
enrolled in a high-deductible health plan. This section removes the HSA plan type
requirement to allow individuals with all types of insurance to establish and use an HSA.
o This would also enable individuals who are eligible for Medicare, VA benefits,
TRICARE, IHS, and members of health care sharing ministries to be eligible to establish
an HSA.
Ø Allowance of Distributions for Prescription and OTC Drugs
o Allows prescription and OTC drug costs to be treated as allowable expenses of HSAs.
Ø Purchase of Health Insurance from HSA Account

Currently, HSA funds may not be used to purchase insurance or cover the cost of
premiums. Allowing the use of HSA funds for insurance premiums will help make health
coverage more affordable for American families.
Ø Medical Expenses Incurred Prior to Account Establishment
o Allows qualified expenses incurred prior to HSA establishment to be reimbursed from an
HSA as long as the account is established prior to tax filing.
Ø Administrative Error Correction Before Due Date of Return
o Amends current law by allowing for administrative or clerical error corrections on filings.
Ø Allowing HSA Rollover to Child or Parent of Account Holder
o Allows an account holder’s HSA to rollover to a child, parent, or grandparent, in addition
to a spouse.
Ø Equivalent Bankruptcy Protections for HSAs as Retirement Funds
o Most tax-exempt retirement accounts are also fully exempt from bankruptcy by federal
law. While some states have passed laws that exempt HSA funds from being seized in
bankruptcy, there is no federal protection for HSA funds in bankruptcy.
Ø Certain Exercise Equipment and Physical Fitness Programs to be Treated as Medical Care
o Expands allowable HSA expenses to include equipment for physical exercise or health
coaching, including weight loss programs.
Ø Nutritional and Dietary Supplements to be Treated as Medical Care
o Amends the definition of “medical care” to include dietary and nutritional supplements
for the purposes of HSA expenditures.
Ø Certain Providers Fees to be Treated as Medical Care
o Allows HSA funds to be used for periodic fees paid to medical practitioners for access to
medical care.
Ø Capitated Primary Care Payments
o HSAs can be used for pre-paid physician fees, which includes payments associated with
“concierge” or “direct practice” medicine.
Ø Provisions Relating to Medicare
o Allows Medicare enrollees to contribute their own money to the Medicare Medical
Savings Accounts (MSAs).
Charity Care and Bad Debt Deduction for Physicians
Ø Amends the Internal Revenue Code to allow a physician a tax deduction equal to the amount
such physician would otherwise charge for charity medical care or uncompensated care due to
bad debt. This deduction is limited to 10% of a physician’s gross income for the taxable year.
Pool Reform for the Individual Market
Ø Establishes Independent Health Pools (IHPs) in order to allow individuals to pool together for
the purposes of purchasing insurance.
Ø Amends the Public Health Service Act (PHSA) to allow individuals to pool together to provide
for health benefits coverage through Individual Health Pools (IHPs). These can include nonprofit
organizations (including churches, alumni associations, trade associations, other civic
groups, or entities formed strictly for establishing an IHP) so long as the organization does not
condition membership on any health status-related factor.
Ø Requires that the IHP will provide insurance through contracts with health insurance issuers in
fully insured plans and not assume insurance risk with respect to such coverage. Allows the IHP

to provide administrative services to members, including accounting, billings, and enrollment
information.
Interstate Market for Health Insurance
Cooperative Governing of Individual Health Insurance Coverage
Ø Increases access to individual health coverage by allowing insurers licensed to sell policies in
one state to offer them to residents of any other state.
Ø Exempts issuers from secondary state laws that would prohibit or regulate their operation in the
secondary state. However, states may impose requirements such as consumer protections and
applicable taxes, among others.
Ø Prohibits an issuer from offering, selling, or issuing individual health insurance coverage in a
secondary state:
o If the state insurance commissioner does not use a risk-based capital formula for the
determination of capital and surplus requirements for all issuers.
o Unless both the secondary and primary states have legislation or regulations in place
establishing an independent review process for individuals who have individual health
insurance coverage; or
o The issuer provides an acceptable mechanism under which the review is conducted by an
independent medical reviewer or panel.
Ø Gives sole jurisdiction to the primary state to enforce the primary state’s covered laws in the
primary state and any secondary state.
Ø Allows the secondary state to notify the primary state if the coverage offered in the secondary
state fails to comply with the covered laws in the primary state.
Association Health Plans
Ø Association Health Plans (AHPs) allow small businesses to pool together across state lines
through their membership in a trade or professional association to purchase health coverage for
their employees and their families. AHPs increase the bargaining power, leverage discounts, and
provide administrative efficiencies to small businesses while freeing them from state benefit
mandates.
Ø While AHPs currently exist, strict Department of Labor standards exist regarding the types of
organizations that may qualify as a single large-group health plan under ERISA. The standard
stipulates that the association must be a group of employers bound together by a commonality of
interest (aside from providing a health plan) with vested control of the association to such an
extent that they effectively operate as one employer. This is considered a difficult standard for
most associations to meet.
Ø Amends ERISA to define AHPs and allow for their treatment as if they were large group single
employer health plans. This definition would allow a dues-collecting organization maintained in
good faith for a purpose other than providing health insurance to benefit from the insurance
regulation exclusions currently afforded to large-group health plans under ERISA.
Ø Requires solvency standards to protect patients’ rights and ensure benefits are paid.
o Requires AHPs to have an indemnified back-up plan in order to prevent unpaid claims in
the event of plan termination.
o AHPs must undergo independent actuarial certification for financial viability on a regular
basis.

Requires AHPs to maintain surplus reserves of at least $500,000 in addition to normal
claims reserves, stop loss insurance, or indemnification insurance.
Anti-Trust Reform for Healthcare
Ø Provides an exemption from Federal antitrust laws for health care professionals engaged in
negotiations with a health plan regarding the terms of a contract under which the professionals
provide health care items or services.
Ø This section applies only to health care professionals excluded from the National Labor
Relations Act. It would also not apply to contracts or care provided under Medicare, Medicaid,
SCHIP, the FEHBP, or the IHS as well as medical and dental care provided to members of the
uniformed services and veterans.
Increasing State Flexibility to Conduct Medicaid Waivers
Ø Provides new flexibilities to states in their Medicaid plan design, through existing waiver
authority in current law.
Ø For many years, including under Obamacare, States have had the option to request a waiver from
HHS to allow states to test new coverage rules under Medicaid and other programs. This
provision would allow states to make changes to their Medicaid plans without interference from
Washington.
Self-Insurance Protections
Ø Amends the definition of “health insurance coverage” under the Public Health Service Act
(PHSA), and parallel sections of ERISA and the Tax Code, to clarify that stop-loss insurance is
not health insurance.
Ø This provision is designed to prevent the federal government from using rule-making to restrict
the availability of stop-loss insurance used by self-insured plans.