Will Tort Reform Lower Healthcare Costs?

Republican presidential candidates have spent more time denouncing “Obamacare” than explaining their own answers to Americans’ health care concerns, but that could change as the campaign winds on, several observers say.

“They ought to be out there talking about what they think the system should look like,” said Michael Franc, a vice president for the conservative Heritage Foundation.

West Des Moines Republican Ed Brown is no fan of President Barack Obama’s Affordable Care Act, but he says it was a response to Americans’ real concerns about the future of health care. “Those concerns will remain no matter who gets elected,” he said.

Brown is chief executive officer of the Iowa Clinic, one of the state’s largest physicians’ groups. He’s a careful follower of health care policy debates, and he recently decided to back former House Speaker Newt Gingrich after wavering among several presidential candidates.

Brown sees the economy and the budget deficit crowding out other important debate topics, including how to keep Medicare and Medicaid costs under control and to prevent Americans from losing private coverage. “Health care isn’t close to being the center of the debate in this election … but once you’re in office it’s going to matter a lot,” he said. He added that he believes measures such as raising the age for Medicare eligibility will be necessary.

Henry Aaron, a health policy expert for the Brookings Institution, agreed that a Republican president would need a specific plan to deal with the fast-rising costs of care and insurance. “If you toss out the Affordable Care Act, the problem is now yours,” he said. “Anything bad that happens will be laid at your feet.”

Aaron said the Republican candidates’ proposals don’t have the same scope as Obama’s. For example, he said, he supports reforming medical-malpractice laws to prevent pointless lawsuits, as most of the GOP candidates do, but he and many other scholars doubt such improvements would go far in cutting overall health care costs. He also said proposals to let Americans buy insurance policies across state lines could lead to somewhat lower prices for some people, but they wouldn’t do much to solve the broader problems.

Aaron also noted that Obama’s health reform program includes several measures supported in the past by conservative thinkers. Those include limits on tax advantages for employers who buy extensive insurance policies for their workers. Many economists have argued that such tax breaks distort the market by encouraging people to have so much insurance that they never directly face any of the costs of their health care decisions. If the Affordable Care Act gets tossed out, the new tax limits will go with it, Aaron said.

One of the most controversial aspects of Obama’s reforms is a requirement that nearly all Americans have health insurance by 2014. Franc noted that several conservative voices, including the Heritage Foundation and candidates Newt Gingrich and Mitt Romney, supported that idea in the past. They saw it as an alternative to a single-payer, government-run health system.

The foundation and Gingrich stepped away from the insurance mandate idea, which now is derided by many conservatives as an assault on freedom. When he was Massachusetts governor, Romney helped push through a 2006 plan requiring nearly everyone in his state to have insurance. He routinely defends the move as a good choice for Massachusetts, but says the federal government does not have the constitutional power to force such a requirement on everyone.

Iowa Rep. Renee Schulte, a Cedar Rapids Republican who is co-chairwoman of Romney’s Iowa campaign, said she thinks many voters will understand his reasoning on the issue. Schulte, who is active on health care issues at the Statehouse, said she and many other Iowans would resist such an idea here. “I can’t say I loved the plan in Massachusetts, but I appreciate the fact that he tried something,” she said of Romney, adding that he had to work with a Democratic legislature.

Schulte said the health care issue has been crowded out of the national debate by overwhelming concerns for the economy and the budget deficit, but she said the fast-rising costs of insurance and Medicaid and Medicare compound both of those problems and must be dealt with. She expects the issue to get more play as the Republican field narrows and each remaining candidate receives more time to speak.

State Rep. Linda Upmeyer, a Garner Republican who is the House majority leader and state chairwoman of Gingrich’s campaign, said Romney’s Massachusetts health plan probably isn’t receiving as much attention lately because it has been hashed over thoroughly.

Upmeyer, a nurse practitioner long involved in health care issues in the House, predicted the Republican presidential candidates would find a receptive audience by continuing to stress that many health care problems are best solved by states instead of the federal government.

All of the Republicans promise to reverse Obama’s health care programs, but they would need help from Congress to scrap it altogether.

Franc, the Heritage Foundation expert, said to fully junk the Obama measures, Republicans would have to win the presidency, retain their House majority and probably gain control of the Senate.

Many bills require 60 votes to move ahead in the 100-seat Senate, but Franc said that shouldn’t be necessary to repeal much of the health care law. The 60-vote level is needed to cut off debate and take a final vote on many kinds of bills, but Franc said senators could invoke a maneuver known as reconciliation to pass a bill with a bare majority of senators. In fact, he said, Republicans could do so with only 50 senators and the vice president as a tie-breaker.

Reconciliation can only be used for bills related to the budget, but Franc said many aspects of the health reform program could be considered applicable. For example, he said, Congress could vote to cut financing for the scheduled expansion of the Medicaid program and for creation of health insurance exchanges, which would be government-run electronic marketplaces on which Americans could buy private policies.

-Via The DesMoines Register

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