Opinion / Politics

How Republicans Can Pass “Trumpcare” – This Month

As published in The Hill, 4/20/2017

Innovative New Provision Would Help Uninsured Americans

When President Donald Trump and Speaker Paul Ryan pulled their bill to repeal Obamacare and reform the health care system in America last month, the press was all too happy to dance on that legislation’s grave.  They hailed it as a sign that the Trump administration was too dysfunctional to get anything done.  But Trumpcare is back from the dead, and Trump and Ryan have learned much in the last few weeks.  In fact, if they play their cards right – and especially if they make one key tweak – there is every indication they will be able to pass their health care reform bill before this month is out.

President Trump is, first and foremost, a strategist.  His canny understanding of the political landscape allowed him to cruise to victory despite being written off by the professional chattering class.  He understood the votes weren’t there yet, and he doesn’t like to lose.  Pulling the bill was the smart choice at the time.  But Trump is also a quick learner, and now has a better understanding of just how hard it is to work with the hundreds of strong-willed independent thinkers in Congress. Armed with that knowledge, he has now begun the slow process of building a consensus of support that will allow him to accomplish his goal.

He is likely working more closely with Speaker Ryan this time around.  It is in both their interests to get the job done and prove to the voters that the new Administration and Congress deserve their respect.

Their first task is to overcome the divisions within the Republican party.  But once they manage that, they will of course face an even greater public relations battle with the Democrats over the law itself.  Bipartisan cooperation is a nice idea, but in today’s Washington, it doesn’t pay to count on that.

Sadly, if the past is prologue, the Democrats will surely put forward charges against the new law and seek to paint it as a disaster for the American people. You can be certain that even if the bill offers improvements, there will be an avalanche of critics pointing out anecdotes of families or individuals suffering under the Republicans’ sinister plan.

Republicans have done well at pointing out Obamacare’s many failures – the most glaring of which being the 29 million Americans still not covered by health insurance despite this law being “on the books” for years.

But that’s not enough.  Trumpcare must offer its own benefits and Republicans must promote them, just as Democrats pointed out the pre-existing condition and age limit increase provisions of Obamacare over and over again.

For instance, they can offer a positive response to the travesty of 29 million still-uninsured Americans by offering a plan to cover more people almost immediately. And that can be done with a simple addition to the bill – a tweak supported by the medical community that would give care to millions of people and save taxpayer money.

Trumpcare should include a provision offering pro bono healthcare from participating doctors to needy Americans.  This would provide for our most vulnerable citizens to receive free health care from a local doctor. The concept is easy to understand: doctors could voluntarily agree to accept up to 20 pro bono patients per year and receive a tax deduction for doing so. The deduction would be equal to their normal office visit fee.

At the end of the year, when they prepare their taxes, the doctors would fill out a one-page form listing how many pro bono patients they served and the value of those visits. Like all tax materials, this would be subject to audit.

The medical community is on board.  The Association of Mature American Citizens polled hundreds of doctors and found over 80 percent would participate. Since there are 400,000 primary care doctors and nurse practitioners in the U.S., if each were to accept 20 patients, over 6 million people would be helped.

Pro bono health care would not only provide coverage for millions of the uninsured, it would also save money by reducing or eliminating costs from Medicaid which presently helps some of our neediest citizens.  President Trump could then be justly credited with providing health care for millions of people who are presently uninsured, while saving the taxpayers hundreds of millions of dollars.

Making pro bono health care a part of the final Trumpcare bill could be the key that secures its already-likely final passage this month.

Dan Weber is the president and founder of the Association of Mature American Citizens, a senior’s organization that represents more than 1.2 million members and stands for fiscal responsibility.

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5 years ago

Trump could also have in the bill competition across state lines.

5 years ago

Here is a potential problem with this idea. The welfare state perpetuates itself by making more people dependent instead of independent. That is why Government has pushed aside and taken over so much of what used to be charity in this country. Charity is not a government alphabet agency doling out money or help. Charity is necessarily from an individual or organization to a needy person, not from a faceless government agency. In this case it is the charity of physicians to those unable to pay for the medical care they need. How does this make anyone more dependent on big government?

5 years ago

Pro bono appeals to the altruists, but it smells like a mandate to me. Leave it up to the doctors to decide whether or not they want to provide free services. And, yes, allow some tax advantage for doing so.
A successful health insurance policy should include many possibilities instead of aiming for a one-size-fits-all strategy. Get some doctors, patients, insurers, and legislators in a room together to come up with some workable ideas.
Here’s one scenario to consider:
I like the idea of the concierge practice, where a group of doctors or a hospital system charges an annual membership fee to cover a predetermined number of visits per person or family for that year. The practice could impose a copay, which would help defray costs associated with running the practice. The free marketplace might lead patients to a different health care system that does not charge a copay or has a lower annual membership fee. Competition in any industry drives down prices, and it is not until the cost of health care comes down that we will finally see insurance rates follow suit.
Now for something unconventional: What if, instead of relying on individual insurance (or that provided by employers), the PRACTICE carried an insurance policy that covered everyone seeking health care? 100% of the patients are covered. Period. This event-centered system may be seen by some to be too expensive, but everyone who has insurance already accesses the benefit when needed. Plus there’s no one showing up at the doctor’s door who will have to figure out how to pay for the visit (practice managers can come up with a payment schedule for unregistered patients), and hospital emergency rooms won’t be crowded with patients who delayed seeking help until they required emergency care.
Insurance companies would love this golden opportunity to write a group policy for a practice comprising a thousand or three thousand patients. That’s easier and less expensive than trying to sell insurance policies to that many individuals or small businesses. So, for people who can’t afford insurance or for those young immortals who say they don’t need it or for those who are morally opposed to accepting subsidies, there’s an alternative. Sounds expensive, I know. Tort reform can bring savings, and consider the fact that many healthy practice members might never need the insurance coverage because they don’t often go to the doctor; their annual allowance covers them. This will become part of the insurer’s calculations. Also, patients won’t be burdened with monthly premiums or $6,000 deductibles, leaving more money in their pockets. There should be an incentive for people to live healthier lifestyles, but let’s be real–those who are able but refuse to do so should expect to pay more. The less often a doctor needs to access the insurer, the less expensive the policy will be–for example, when the doctor decides not to file a claim for the last $30.00 of a bill. This will help bring down health care costs,
What’s missing from this picture? Why, the government, of course! Certainly there will be regulations, but this is as close to the private doctor-patient relationship as we can get. Suits me.
This might be entirely unworkable, but I think that new approaches to our problems are called for.

5 years ago

Health insurance will never be any good as long as the government is involved they need to put it back in the hands of the insurance people and leave it to them

5 years ago

Not Trumpcare, Health care period. Repeal completely. What we had before was certainly better then what we have now or will have with any government controlled system.

5 years ago

We can only hope & pray that TrumpCARE, RINO RyanCARE, obamaCARE are all defunded, closed, shut-down & all assets sold…….that NO attempt is made to fix/correct/adjust any current fiasco……..the VA with their massively corrupt Disabled Veterans Care should also be defund.

5 years ago

The Constitution does not say anything about it, but sure, everyone can purchase health insurance; nothing says that I have to pay for someone else’s. I have medical bells from before 1965, before Johnson decided the government should buy votes for his party by “giving ” retires Medicare. The bills were much lower, considering the government inflation, and the care was not rationed.
The last election was won on the promise to REPEAL Obamacare. Ryancare is just another Federal giveaway, with new “entitlements” (vote purchases.)
Let’s completely repeal Obamacare, Then we can argue about what of my income Congress wants to give away. Can you name one Federal program that works? AMTRAC, Post Office, Medicaid, NASSA (which was charged with making peace with Iran), Etc..

5 years ago

Booms care includes many provisions for seniors like reducing the donut hole and many more will these be included in the new bill

5 years ago

Booms care includes many provisions for seniors like reducing the donut hole and many more will these be included in the new bill?

5 years ago

What about the provisitions that obomacare includes many provisions for seniors like reducing the donut hole and may more will these be included in the new health care bill?

Russell McClellan
5 years ago

Your idea of “pro bono” care is a good start, but would be subject to abuse and would be difficult to audit. It recognizes the difference between health “care” and health “insurance”.

My idea is similar to yours.
Each state would define a group of folks who are uninsurable. Then those folks would be taken care of by the state.

Doctors who provide care for those folks could obtain personal income tax deductions for that care based on Medicare reimbursement rates.

This would:
A) Allow physicians to reduce their personal income tax burden (potentially to zero, but no further).
B) Provide care for patients at pennies on the Medicare dollar (since the amount written off would be based on the physicians personal tax bracket)
C) Physicians would do this with a smile since it is the only way to effectively eliminate their tax burden
D) Presumably it would attract top notch physicians to participate since they would have the greatest tax burden to write off.
E) Basing it on established Medicare rates would allow easier tracking subject to less abuse. The HHS could issue a yearly statement to each participating physician to be included is their personal income tax submission.

Jim Nicolletta
5 years ago

If the pro bono addition would include illegal immigrants or non citizens I would be totally against including it..so what is the status of that issue as it pertains to the pro bono provision.

Chuck G
5 years ago

Here we go again. The official spokesman of AMAC proposing more effective socialism than “the other guys”.
I read a lot of replies urging us to contact our representatives but I’ll bet not one in a 101 does.
Senate: S. 106 . call 202.224.3121 to urge your senators to co-sponsor it
House: H.R. 1718. call 202.225.3121 to urge your representative to co-sponsor it.
Instead of protesting here;; Take Action. You remember what Kruschev said when touring America. “Ha Ha, protest?, that’s what a
rat does when you catch him under the heal of your boot.”
Quit protesting, ACT!!!

John Higgins
5 years ago
Reply to  Chuck G

HSA’s are not socialism- they give the power back to the people!

5 years ago

Typical GOP strategy. They had 6 years to GET READY…nope didn’t bother, because they had no plan. They lied and said they would repeal it to get elected. They never thought Trump would win ( tried to prevent it). Then NOT do what Trump promised- REPEAL OBAMACARE. pitiful. Exactly WHY we elected Trump. GOP is dead to me..

Jo Novak
5 years ago

Repeal, do NOT replace. Gov’t has NO business in healthcare.

5 years ago

What the heck happens when the pro bono doc orders labs, meds or procedures? Do all other providers for the patient need to pony up free care?

Henry J
5 years ago
Reply to  Deb

The whole thing is voluntary. Only if they want to.
Ask your doctor if he/she would participate. I asked mine and he said he would.

William Lee Kohler
5 years ago

President Trump PROMISED to REPEAL Ohomocare! Reworking it and keeping government socialized medicine is NOT getting the job done! REPEAL and NO less! What is needed is to LOWER medical cost below what they were 8 years ago and lower yet. That was the supposed rationale
for Ohomocare but was a complete LIE and likely intentionally so from the beginning. Unless it is REPEALED there are a whole bunch of us that will still NOT accept it. Hopefully the congress will not either.

Henry J
5 years ago

Good idea! Repeal without covering the 14 million people who get some kind of assistance! Also- stop Medicaid and let them have no coverage too.
So who cares if the media kills the Republicans and they lose both the House and Senate and two years later the White House. Then we can all have single payer controlled by the Federal Government.
Or should they dump all the mandates and taxes now and slowly replace government handouts with the Free market?

5 years ago

Don’t need TrumpCARE, or obamaCARE……don’t want……..just look at the VA attempt at Health Care for just a few million…… so massively corrupt it can’t be fixed……has raised Health care Costs……..DEFUND TrumpCARE, obamaCARE, RyanCARE, & VA Care.

5 years ago

The ‘pro-Trumpers’ voted for him to be President of the United States, not to piece-meal it. Real its entirely. We do not need tax reform until the ObamaCare taxes and its health care are off the books. Real then reform.

5 years ago

“Trumpcare” has two major flaws, and as such is extremely dangerous. First, just like its parent, obamacare, Trumpcare does NOTHING to bring down the actual cost of health care services, which is what was wrong with our health care system in the first place. Second, extorting money from citizens by forcing them to buy something they may not even want wildly exceeds government’s constitutional mandate, pronouncements to the contrary coming from a radicalized supreme court notwithstanding. Nationalized, forced healthcare needs to go!

The danger of Trumpcare is, if this thing is approved and implemented Trump and the Republicans now own the beast. It’s they who will be blamed when, not if, it implodes. There’s an excellent proposal on the table right now, the Brooks bill. It needs to be passed and implemented, returning health care to the free and open marketplace, where it belongs.

Don’t be fooled by irrelevant and questionable data being thrown out to obfuscate things. Case in point, the “29 million people who still have no health care coverage”. How many of those 29 million people WANT health care insurance? And if given the opportunity, how many people who are currently paying for forced health care coverage that actually covers little or nothing at all would QUIT immediately?

Healthcare for the masses isn’t an issue for a special interest group like AMAC in the first place. Most of us are seniors and as such are exempt from obamacare. We face instead another financial sinkhole quagmire, Medicare. Let’s work to reform Medicare and forget about trying to pass Trumpcare.

5 years ago
Reply to  steve

Forcing people to buy anything is an organized crime action, a paid protection racket. With all other insurances we don’t have to buy it. You don’t have to buy auto ins. unless you own and drive a car. Furthermore, it doesn’t make sense to call it a tax. That’s just a slight of hand to make it “legal”. I can stand in a garage, go vroom vroom, and call myself a car, but that doesn’t make it true or real. All of it seems to just be a way for the crime cartel (sadly, our gov.), to increase control and domination of all the people.

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