How Republicans can crack down on health care reform

Nearly eight out of ten Americans are “very” or “fairly concerned” about the availability and affordability of health care, according to a survey by the market research institute Gallup.

So it's surprising that this year's Republican Party platform doesn't devote much space to this issue. Even the disastrous policies of the Biden-Harris administration are barely discussed – from restricting short-term health insurance plans to imposing price controls on prescription drugs to overly generous health insurance premium subsidies through the Obamacare exchanges.

Republicans should not leave health care reform to the Democrats. Voters want to hear what they plan to do on this issue. Market-oriented reforms and a smaller role for the federal government can win votes.

Just eight years ago, the Republican platform for 2016 focused on market-oriented, fiscally responsible measures such as raising the Medicare eligibility age, restructuring Medicaid around block grants to states, and repealing the Affordable Care Act. This time, Republicans seem to have abandoned their clear policy positions in favor of vague promises.

Consider the Republican promise to “fight for and protect Medicare without cuts, including no change to the retirement age.”

Keeping that promise will be difficult given the budget bill. According to the Medicare Board of Trustees, Medicare's Part A Hospital Trust Fund will run out of money in 2036.

A gradual increase in the Medicare eligibility age would help preserve the program for future generations who live longer and healthier lives today than they did nearly 60 years ago when the eligibility was introduced. Over the past sixty years, the number of Americans age 85 and older has increased more than sixfold. Adjusting the Medicare eligibility age to reflect rising life expectancies makes sense—especially given the program's long-term financial challenges.

In their program document, Republicans also promise to “increase transparency, promote choice and competition, and expand access to new options for affordable health care and prescription drugs.”

That's good, but vague. Let's fill in the gaps.

One way Republicans can increase “transparency” is by enforcing the Trump administration's federal rules requiring hospitals to publish their prices in accessible, machine-readable files. Nearly two-thirds of hospitals still don't comply.

To “promote choice,” Republicans may roll back the Biden administration's restrictions on short-term health insurance. Short-term plans can take an applicant's health status and medical history into account when setting premiums. They are also exempt from the Affordable Care Act's requirement that insurance cover 10 “essential health benefits” regardless of whether someone wants or needs them. So they can cost much less than insurance from an exchange.

About 3 million people took out short-term insurance plans in 2019. But in March of this year, the Biden-Harris administration effectively banned these plans by limiting their duration to just three months with the option of a one-month extension.

Republicans can increase “competition” by removing the price controls that Democrats imposed on prescription drugs with the Inflation Reduction Act. These price controls will undermine the incentive for generic drug manufacturers to enter the market once patent protection on drugs expires.

As for expanded “access” to new drugs, the IRA's price controls also force drugmakers to drastically cut their investment in research and development. Removing these controls would provide an immediate boost to American innovation.

Perhaps the best way for Republicans to save on prescription drugs in the short term is to curb the parasitic role of pharmacy benefit managers, who extort deep discounts and rebates from drug manufacturers in exchange for a top spot on their insurance customers' drug lists or covered drug lists.

But these savings typically do not accrue to patients at the pharmacy counter. The majority of these savings are retained by insurers and PBMs. Patients should share in these savings.

There are many bad health care policies. Republicans can make big gains with voters by filling the gaps in their program.

Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow for Health Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on X, formerly Twitter, @sallypipes.