House Republicans Float Free-Market Health Care Bills

Comprehensive proposal offers alternative to Medicare for All

Rep. Bruce Westerman / Getty Images
February 26, 2019

Two Republican congressmen introduced proposals Tuesday designed to fix America's health care system through a variety of market-oriented reforms.

Despite recent efforts to the contrary—most prominently through the Affordable Care Act—the American health care system continues to suffer intractable issues of coverage and cost. Even after the implementation of Obamacare, 29 million Americans remain uninsured. Personal expenditures on health care have also continued to rise, with costs reaching 18 percent of GDP in 2017.

Many prominent Democrats, including 2020 contenders, have publicly embraced Sen. Bernie Sanders's (I., Vt.) proposal to expand Medicare to cover all Americans. Such a single-payer system would, at least on paper, provide universal coverage. However, critics argue that the proposal would be prohibitively expensive and would represent an unwarranted and unprecedented expansion of state power into the marketplace.

Republicans have been slow to propose a comprehensive alternative, which may have hurt their efforts to repeal and replace Obamacare under undivided government. The proposals released Tuesday, from Reps. Bruce Westerman (R., Ark.) and Jim Banks (R., Ind.), represent one attempt at filling that gap.

"I promised my constituents to work every day to repeal and replace Obamacare. And even though Republicans two years ago fell flat on their face in that effort, I will continue that fight each and every day that I'm a member of Congress," Banks said at a Tuesday roll-out of the bills. "But the reality of Democrat control of the House means that we need to find ways to work together to lower health care costs."

The main proposal from the pair is Westerman's Fair Care Act of 2019. The comprehensive bill, according to Westerman's office, "addresses major drivers of health care costs as well as obstacles hindering individuals from obtaining health insurance coverage."

It aims to do so through a bevy of changes to the health care market. Many of the bill's provisions target availability of insurance to those who otherwise lack access, most prominently by implementing a system of invisible high-risk insurance pools. It also allows the setting up of short-term limited duration plans and associated health plans, which Westerman said Tuesday would increase competition.

Competition, in fact, is at the heart of the FCA, which includes Banks's Hospital Competition Act of 2019. Provisions of that bill, incorporated by the FCA, would work to expand the supply of hospitals, responding to an industry that has grown increasingly concentrated in recent years. The HCA would, among other provisions, require hospitals in highly concentrated regions to accept Medicare reimbursement rates from commercial payers, dragging down profits; it would also expand the Federal Trade Commission's staff responsible for overseeing the effects of hospital mergers.

In addition to inter-hospital competition, the FCA would try to increase competition among pharmaceutical firms to help cut the cost of non-genericized drugs, primarily by limiting the period of exclusivity for certain drugs and accelerating the availability of generics.

The FCA would additionally repeal a number of taxes on health insurers, which Westerman said are often passed on to consumers, as well as the employer mandate included in Obamacare.