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Please check out the whole thing from an all-star lineup — Joseph Antos, James Capretta, Lanhee Chen,Scott Gottlieb, Yuval Levin,Thomas P. Miller, Ramesh Ponnuru, Avik Roy, Gail Wilensky, and David Wilson.
The report covers the ACA, Medicare, and Medicaid. But I wanted to highlight this on moving forward the Obamacare debate:
The starting point for renewing American health care must be replacement of the ACA with a genuine, consumer-driven approach to expanding health insurance coverage. The ACA moved power and authority over the direction of US health care from consumers, employers, and the states to the federal government. A replacement plan must be built on a more decentralized approach, with consumers given the ability to make choices for themselves and authority returned to the states to oversee health care markets.
1) Most Americans get their health insurance today from their employers, and that should not change with a new reform plan. Employers should be free to organize health insurance offerings that are attractive to their workers. The existing federal tax break for employer-paid premiums should be retained. The only modification should be an upper limit to inject additional cost discipline into the most expensive plans.
2) Those Americans without access to employer coverage should be given a refundable, age-adjusted tax credit that is set roughly equal to the average tax break for an employer plan. These tax credits could be used to purchase any health insurance plan approved for sale in a state.
3) All Americans should be given continuous coverage protection in an ACA replacement plan. This rule would protect persons with preexisting conditions from being charged more, or denied coverage, based on their health status so long as they have not experienced long breaks in insurance enrollment.
4) States could also boost insurance enrollment by assigning persons who are eligible for the tax credits but have failed to pick an insurance policy to a default insurance plan. The upfront deductibles for these insurance plans would be set as necessary to ensure the premiums for enrollment would be equal to the federal tax credit, thus ensuring no additional premium would be required from a person assigned to a default plan. …
5) HSAs should be a central component of health care in the United States. The accounts provide strong incentives for their owners to seek the best value for their health care purchases, and they provide a ready vehicle for providing additional protection against high medical expenses. Existing rules should be modified to allow all Americans to make annual contributions to an HSA, and a new, one-time federal tax credit would provide a strong incentive for those without accounts to establish them. HSAs should also be fully integrated into the Medicare and Medicaid programs.
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