And affected employees would likely not be pleased with the prospect of higher out-of-pocket costs.
For example, tampering with the time-honored (if regressive) tax exemption extended to employer-sponsored health plans would rile up the employer lobby. The PCA, like other health reform proposals, struggles to juggle multiple difficult trade-offs against the backdrop of deeply entrenched and often powerful interest groups. Other features of the PCA include the conversion of the federal component of Medicaid into a state-run block grant (per capita cap) program, the facilitation of the sale and purchase of health insurance plans across state lines, the amplification of consumer-serving transparency on cost, quality, and outcomes, and the capping of monetary damages and attorney fees awarded in the wake of medical malpractice litigation. Instead, greater reliance is being placed on targeted means-tested tax credits to eligible individuals (those earning less than 300% of the federal poverty level) in search of private health insurance inclusive of current Medicaid enrollees.
And gone is the time-honored open-ended tax exemption on the value of employer-provided health plans instead, health benefits exceeding $12 000 for individuals and $30 000 for families would be taxed as income for the employee.Ībove and beyond the preceding provisions, the PCA has all but done away with the federally subsidized expansion of Medicaid by the ACA. Gone (not to be replaced) are the employer mandate, the federal health insurance exchange, the progressive Medicare payroll tax, the medical device tax, and the health insurance premium tax. Gone are the federally mandated essential health benefits, which would be replaced by state-defined mandates.
Under the PCA, gone is the individual mandate requiring that US individuals purchase health insurance or pay a penalty if they don’t (a hedge against people not buying insurance until they need it), to be replaced by lower premiums for younger enrollees, courtesy of revised age-rating ratios and by the “continuous coverage” mandate. However, that is where the similarities end. Finally, the all-important reliance on targeted sliding-scale tax subsidies for the purchase of insurance by low- and middle-income families has also been preserved, albeit in a modified form that would make them available to fewer people. The right to health care coverage in the face of preexisting conditions has also been retained, although this guarantee would apply mainly to people who had maintained continuous health insurance coverage. These include the accommodation of adult children (younger than 26 years) on parental health plans (although the PCA would allow states to opt out of this provision), the prohibition of total lifetime dollar limits on covered benefits, and the $700 billion in Medicare cuts. Some provisions of the ACA have been retained by the PCA. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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