Obamacare has been an abject failure. It has not provided universal health insurance coverage as was promised nor has it controlled the ever rising cost of health care. Only 40 percent of people uninsured when the Affordable Care Act became law are now insured. All Americans, except for people in the Medicaid entitlement, have seen their health care expenses go up.

Congress was unable to repeal or replace Obamacare in 2017. Realistically, Congress will not consider any further health care reform legislation until after the 2020 election.

But a reasonable, comprehensive alternative to Obamacare exists. (here)

The Congressional Republican Study Committee has put together a proposal that retains the popular features of the ACA, retains Medicaid as a safety net program for the truly needy, and most importantly gives patients much more control over their health care.

The plan eliminates the employer mandate and gives the employer tax credit to individuals through health savings accounts. People can contribute to their HSAs using pre-tax dollars, can watch the funds in their HSAs grow tax-free, can use those dollars for an expanded list of health care expenditures, and can withdraw that money without paying taxes. From a practical standpoint, this eliminates the distortion caused by existing tax laws that favor employer-paid health benefits.

The maximum contributions to HSAs would increase to $9,000 per year for individuals and $18,000 for families. HSAs could be used for an expanded list of health care related items such as direct primary care, health status insurance, and paying for health insurance. The requirement for an accompanying high deductible health insurance plan would be eliminated.

Polls show that Americans like the pre-existing condition and the guaranteed issue clauses in Obamacare. The Republican plan addresses these items by prohibiting pre-existing condition exclusions and by the use of state-based guaranteed coverage pools. The plan also allows states to provide alternatives such as high-risk pools to cover patients with high costs and high utilization.

The plan also allows the purchase of new insurance before COBRA funds are exhausted and encourages the use of short-term, limited-duration health insurance plans for people in transition from job to job or from working to enrolling in Medicare.

Medicaid is not sustainable in its current form. The Republican plan places a moratorium on further expansion of the entitlement and would give states more control over the program through the use of per capita block grants. It would also give states more flexibility by allowing greater use of the individual private market to cover Medicaid patients and by allowing states to combine their children in the CHIP program with the Medicaid program.

Finally, the plan would expand the use of innovative care through greater use of:

• Direct primary care;
• Health care sharing ministries;
• Association health plans;
• Health status insurance (basically a form of re-insurance to cover unforeseen medical expenses);
• Short-term, limited-duration plans;
• Telemedicine;
• The repeal of Certificate of Need laws.

The current health care debate revolves around some form of single-payer or Medicare for All program as opposed to incrementally expanding government control with a public option or a Medicare buy-in. On the other hand, the latest Republican plan would be a good start toward meaningful health care reform that puts patients, not the government, in charge of their own medical care.