Ten Questions to Respectfully ask a Conservative about Healthcare

YAY ACA outside Julia Brownley's Town Hall

The lone Trump supporter at the ACA Town Hall meeting last night said that she felt that her concerns were not being heard. Another audience member asked her if she could describe her vision for health care in America. She didn’t answer, so the mystery continues.

What, exactly, do conservative voters want? Is it really different than what we want?

We know what the President promised them…

“We’re going to have a plan that’s going to be great for people”. We’re going to have insurance for everybody…There is a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us”.

Well, that sounds awesome! Who could not like that?

However, the few details he’s provided, such as tax deductions and block grants, suggest otherwise, as they’ve been proven to hurt low-income people. The GOP in Congress have made no such wild promises and are working on how to sell the repeal. There is a serious disconnect here in the making and we need to leverage it to help protect the ACA and make it better.

Your homework assignment: Ask a conservative you know to describe the perfect insurance/healthcare system. No judgements, no arguments. Just get their vision.

You can ask them, point by point, or just follow them to where they go.. then write it up as succinctly as possible and tell us here what you find out in the comments section!

1. Do you think there should be “Coverage Caps”?


ACA: Annual and lifetime coverage caps on essential benefits were banned. (1)

Price: Repeal ACA prohibition on lifetime and annual limits (which also harms those with pre-existing conditions and chronic illnesses/diseases) (2)

2. Do you think the following services should be included in basic insurance policies?

– Hospitalization?
– Ambulatory patient services?
– Emergency Services?
– Maternity and newborn?
– Mental health and substance abuse disorders?
– Prescription Drugs?
– Rehab services and devices?
– Lab work
– Preventative and wellness
– Chronic disease management
– Pediatric services
– Oral care
– Vision care

ACA: Insurance polices must cover essential health benefits. (“Essential health benefits” are defined by the National Academy of Medicine as “ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care” as well as others.) (1)

Price: Repeal ACA essential health benefit standards (which include things like surgery and overnight hospital stays, pediatric services, maternity services, emergency services, prescription drug coverage, and birth control) Repeal mental health parity requirements for individual market and small-group market policies (2)

3. Do you think kids should be able to stay on their parents’ policy until the age of 26?

ACA: Dependents can remain on parent’s insurance until the age of 26. (1)
Price: Repeal ACA provision that dependents can stay on their parents’ insurance until the age of 26. (2)

4. Do you think there should be annual limits on out-of-pocket cost sharing with insurers?

ACA: All health policies sold in the United States must provide an annual maximum out of pocket (MOOP) payment cap for an individual’s or family’s medical expenses (excluding premiums). After the MOOP payment cap is reached, all remaining costs must be paid by the insurer. (1)

Price: Repeal ACA limits on annual out-of-pocket cost sharing. (2)

5a. Do you think insurers should be required to offer the same price insurance to applicants of the same age and location?
5b. Do you think people with pre-existing conditions or chronic conditions should pay more or not be covered?
5c. Do you think the elderly should pay more than 3x what younger people pay?

ACA: A partial community rating requires insurers to offer the same premium to all applicants of the same age and location without regard to gender or most pre-existing conditions (excluding tobacco use).] Premiums for older applicants can be no more than three times those for the youngest. (1)

Price: Repeal overall prohibition on pre-existing condition exclusions. Requires “continuous coverage” to maintain exemptions for pre-existing conditions. Can deny coverage based on health status for applications outside OE and SEP enrollment periods. (2)

6. Do you think making basic preventative care, vaccinations and medical screenings free is a good policy?

ACA: Preventive care, vaccinations and medical screenings cannot be subject to co-payments, co-insurance or deductibles. Specific examples of covered services include: mammograms and colonoscopies, wellness visits, gestational diabetes screening, HPV testing, STI counseling, HIV screening and counseling, contraceptive methods, breastfeeding support/supplies and domestic violence screening and counseling. (1)

Price: Repeal ACA preventive health benefit standards (the services most used by young people, including routine physicals, various cancer screenings, and well woman visits). (2)

7. Do you think patients should be able to appeal an insurance company’s coverage determination and claims?

ACA: Insurers are required to implement an appeals process for coverage determination and claims on all new plans. (1)

Price: Repeal ACA right to independent external appeal of denied claims. (2)

8. Do you think insurers should spend at least 80-85% of their premiums on health care?

ACA: Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued to policyholders if this is violated. (1)

Price: Repeal % requirement. (2)

9. Do you think Medicare coverage should be improved?

ACA: Gradually close the “Donut hole” of Part D coverage. Prohibit Medicare Advantage plans from imposing higher cost-sharing requirements for some Medicare covered benefit than is required under traditional Medicare. Eliminate cost-sharing for preventive services, waive deductibles for colorectal cancer screening tests. Increase premiums for higher income beneficiaries. (1)

Price: Remove all Medicare provisions in the ACA. Allow physicians to enter into private contracts with Medicare beneficiaries for the amount they can charge Medicare and allow patients to seek some reimbursement from Medicare. Pre-empt state laws limiting the amount providers can charge for covered services. (2)

Ryan: Convert Medicare into a premium support system. Patients receive a defined contribution payment, adjusted for health status and income, to purchase a private plan or traditional fee-for-service. Combine parts A&B with a single deductible 20% cost-sharing on all covered services,and annual limit on OOP expenses. Increase age of eligibility from 65 to 67. (2)

10. Do you think individuals and large employers should be mandated to obtain health insurance?

ACA: Yes. Employers of 50 or more most offer plans meeting standards for affordability and minimal value. Employers of more than 200 employers to auto-enroll employees in the group health plan. Individuals must either be covered by their employer or purchase insurance. No prohibitions on pre-existing conditions.Exemptions granted for affordability, financial hardship, religious objection, other reasonings. (1)

Price: No requirements for large employers to provide health benefits that meet minimum value and affordability standards.For individuals, tax credits would be used for purchasing health insurance. May have pre-existing prohibitions depending on when an individual applies. (2)

(See http://thehill.com/policy/healthcare/315387-what-we-know-and-dont-know-about-trumps-healthcare-plans)

  1. Wikipedia’s entry on the ACA
  2. Tom Price’s interview in Money, 1.24.17.
  3. Other information filled in from this, which is a comparison of various insurance proposals – http://kff.org/interactive/proposals-to-replace-the-affordable-care-act/)

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