To fix health care, try putting patients in charge

It’s bad enough that the Supreme Court recently failed to overturn the ironically named Affordable Care Act (“Obamacare”). Now Democrats in Congress appear poised to double down by further expanding the program, papering over its failures with more taxpayer funds.

That’s a shame, because the law’s driven up costs and reduced choices. Premiums more than doubled by 2019, from $244 a month in 2013 to $558 nationally — tripling in five states. The number of insurers selling coverage fell from 395 before Obamacare was implemented to 253 this year.

Only five states — 10% — have more insurers offering individual exchange coverage in 2021 than before the ACA, while 14% are the same, and 76% are worse off.

Many insurers have kept costs down by funneling patients through narrow networks. “Increasingly, enrollees are being denied access to the best doctors and the best hospitals,” according to economist John Goodman. “The Affordable Care Act triggered a race to the bottom, as health plans have been trying to attract the healthy and avoid the sick.”

Mr. Goodman found that this practice has made it harder for patients to access not only cancer care and specialty drugs, but the best hospitals and doctors.

So who’s benefited? Insurance companies in the program – which, Heritage research shows, now receive almost 74% of their revenue from taxpayers. Even worse, the law stipulates that under Obamacare’s subsidy system, the higher that insurers raise their premiums, the more money they get from the government. That’s a recipe for the higher costs and reduced value.

It’s not just Obamacare that’s the problem. Other laws are preventing patients from getting the care they need and want. For example, too often sick people can’t access specialized plans that treat their needs; workers can’t keep their doctors and plans when they switch jobs; and it’s often impossible to find out the price you’ll pay for medical care before you get it, let alone benefit financially when you choose lower-cost care.

Federal laws also make it unnecessarily hard to see a primary care doctor of your choice, and to save for and finance your health care needs in ways that let you control where the dollars go.

Thankfully, there are alternatives. The Health Care Choices Proposal, developed by dozens of free-market and conservative thinkers, advances notable ones. It offers a new policy path that puts you and your loved ones in control of your health care without asking Washington politicians or health insurance bureaucrats for permission.

It’s a path that builds on recent promising trends. The last four years saw steps in this direction, thanks in part to actions by the previous administration. For example, we’ve seen regulatory relief open new options for coverage, make it easier for people to take their coverage and doctors from job to job, slash red tape so patients and doctors can visit via telehealth tools, and even moderate premium increases in Obamacare while increasing access to new plans.

For example, in the past few years, states were able to gain regulatory relief from the law’s mandates, through “Section 1332 waivers.” In six states that sought this relief, average premiums fell. A big component of this relief was allowing states to target funds directly to offsetting higher costs from those who are very sick.

While this is good news, there’s still a lot of room for improvement: Despite this good news, the market is still 36% less competitive.

That’s where the Health Care Choices Proposal would come in. Independent estimates by the Center for Health and Economy, in a study commissioned by The Heritage Foundation, found the proposal will lower premiums by up to 24%, cover nearly 4 million more people through private coverage, and improve access to medical providers by 8%. The proposal achieves these results by addressing the many government barriers in the way.

Fixing these problems will require Congress to act, so all Americans can get the health care they want from the doctors they trust. The Health Care Choices Proposal gives Congress the roadmap it needs to address real underlying problems in our system, not paper them over with still more taxpayer spending.

• Marie Fishpaw is the director of domestic policy studies at The Heritage Foundation. Jessica Anderson is the executive director of Heritage Action for America.

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