Sally Pipes is trying to provide ideas the Republican presidential nominee (or surprisingly independent Democratic nominee) could use to create an alternative to the Patient Protection and Affordable Care Act (PPACA) commercial health insurance provisions.
She sees big insurers’ unhappiness with the PPACA exchange system as a sign that the need for an emergency replacement effort may be coming sooner rather than later.
Can the PPACA public exchange system survive into 2017?
“Probably not,” Pipes said Tuesday in an interview. “That’s going to cause an implosion. The exchanges are in a very precarious situation.”
Pipes, the president of the Pacific Research Institute for Public Policy, recently released a book, The Way Out of Obamacare, that outlines ideas for creating a market-based PPACA alternative.
Her proposal includes the use of a combination of vouchers and grants for states to change Medicare and Medicaid; increased use of health savings accounts (HSA); and a shift toward age-based health insurance subsidy tax credits, and away from the current income-based tax credits, which require the recipients to predict how much income they will earn in a future calendar year.
She said she drew on ideas from other proposals, from people like House Speaker Paul Ryan, Rep. Fred Upton, Rep. Tom Price and Sen. John Barrasso when she wrote her book. Despite the knock that Republicans have been slow to propose PPACA alternative plans, the Republicans have actually proposed many alternatives, Pipes said.
She said the country needs to get rid of PPACA and start from scratch. ”We don’t need Obamacare Lite,” she said. “We need the whole law to be repealed and replaced.”
Otherwise, she said, some Democrats may view problems with the current system as justification for moving closer to the completely government-run single-payer system that Canada has.
She noted that each province runs its own health care system. She grew up in British Columbia.
In British Columbia, she said, a kind of union for doctors negotiates with the health program managers to set reimbursement rates. If the program runs out of cash for elective procedures at some point during the year, doctors who want to be paid for their work have to stop performing those procedures and wait until January to get back to work.
She said she is surprised that reporters have been so slow to ask Bernie Sanders, the Vermont senator who is one of the top contenders for the Democratic presidential nomination, about the Vermont governor’s decision to give up on trying to set up a single-payer health care system there.
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