Nearly eight in 10 Americans are “very” or “quite” worried about the availability and affordability of health care, according to a Gallup poll.
So it’s surprising that this year’s Republican platform devotes so little space to the topic, even to the disastrous policies of the Biden-Harris administration, from restricting short-term health insurance to prescription drug price controls to offering overly generous premium subsidies for insurance through the Obamacare insurance exchanges.
Republicans shouldn’t cede health care to Democrats. Voters want to hear what Republicans plan to do about it. Market-based reforms and a smaller role for the federal government could be vote-winners.
Just eight years ago, the Republican Party’s 2016 platform focused on pro-market, fiscally responsible policies, such as raising the Medicare eligibility age, restructuring Medicaid around block grants to states, and repealing the Affordable Care Act. This time around, Republicans appear to have abandoned clear policy positions in favor of vague promises.
Consider the Republican promise to “fight for and protect Medicare with no cuts, including changing the retirement age.”
Budgetary math on this promise will be tough: Medicare’s Part A Hospital Trust Fund is set to run out of money in 2036, according to the Medicare Board of Regents.
Gradually raising the Medicare eligibility age would help sustain the system for future generations, who are living longer and healthier lives than when eligibility began nearly 60 years ago. Over the past 60 years, the number of Americans aged 85 or older has increased more than sixfold. Adjusting the Medicare eligibility age in line with increasing life expectancies makes sense, especially given the system’s long-term financial challenges.
In their policy platform, Republicans also promise to “increase transparency, promote choice and competition, and expand access to new affordable health care and prescription drug options.”
That’s good, but vague. Let me fill in the blanks.
Republicans could start to improve “transparency” by, for example, enforcing the Trump administration’s federal regulations that require hospitals to publish prices in accessible, machine-readable files; roughly two-thirds of hospitals still are not in compliance.
To “promote choice,” Republicans could roll back the Biden administration’s restrictions on short-term health insurance. Short-term plans can take into account an applicant’s health status and history when setting premiums. They’re also exempt from Obamacare’s requirement that insurance cover 10 “essential health benefits” whether you want them or need them, making them much cheaper than insurance on the insurance exchanges.
About 3 million people enrolled in short-term plans in 2019. But in March of this year, the Biden-Harris administration effectively banned short-term plans by limiting their duration to just three months with a one-month extension option.
Republicans could promote “competition” by eliminating price controls imposed by Democrats on prescription drugs through the Stop Inflation Act, which reduces the incentive for generic drug makers to enter the market when drugs go off patent.
As for expanding “access” to new drugs, the IRA’s price controls also pressure pharmaceutical companies to cut their investments in research and development. Removing these controls would immediately boost innovation in the United States.
Perhaps Republicans’ best opportunity to save on prescription drug costs in the short term is to curb the parasitic role of PBMs, or pharmacy benefit managers, which receive huge discounts and kickbacks from drug companies in exchange for preferential placement on insurer customers’ formulary, or covered, drug lists.
But these savings are typically not passed on to patients at the pharmacy counter. The vast majority of savings are kept by insurance companies and PBMs. Patients should share in the savings.
There’s a lot of bad health care policy out there, and Republicans could gain significant support from voters by filling the policy gaps.
Sally C. Pipes is president, CEO, and the Thomas W. Smith Fellow in Health Policy at the Pacific Research Institute. Her latest book is “False Premise, False Promise: The Disasterous Reality of Medicare for All” (Encounter 2020). Follow her on Twitter: @sallypipes.
