What the Senate health bill involved | Guest

Obamacare is broken and we need to fix it. Since 2013, insurance premiums have more than doubled in the United States. This fall, families in North Dakota will need to brace themselves for another double digit increase in their health insurance costs. These increases are unsustainable for our families and our businesses, and that’s why we have been trying to reform our health insurance system.

Through this process, there are a few guiding principles that I have followed. First, we need to give individuals and families more choices, not force them to buy one-size-fits-all policies, paying for coverages that they neither want nor need. Next, we need to ensure coverage for those who truly can’t afford insurance by preserving Medicaid. Finally, we need to bring down the cost of health care by reducing federal regulation and empowering our states to be innovative in their approach to health care coverage.

Over the last few days, the Senate voted on several versions of legislation that would have started the process of reforming our health care system. These bills would have ended the individual and employer mandates and helped restore Americans’ ability to choose their health care coverage. At the same time, they would have provided states with greater flexibility to innovate free from mandates imposed by Washington.

The Health Care Freedom Act would have:

• Repealed the individual mandate.

• Repealed the employer mandate for eight years.

• Repealed the costly medical device tax for three years.

• Increased the contribution limit for health savings accounts.

• Provided greater flexibility to the states through the 1332 waiver process.

• Defunded Planned Parenthood for one year and increased funding to Community Health Centers by $422 million.

• Continued to fund Medicaid expansion and did not impact traditional Medicaid.

 The Better Care Reconciliation Act that we actually voted on in the Senate was significantly different from the original draft. I worked with others to add more than $200 billion in a long-term stability fund and important Medicaid provisions to make sure low-income individuals had coverage.

Under the revised BCRA, North Dakota would have received a similar amount of resources as under the Affordable Care Act (Obamacare), but with more flexibility and a variety of new tools to meet the needs of patients and the state. Between Medicaid, the refundable tax credits, the long-term state stability fund, a new substance abuse treatment fund, and additional federal resources to cover the treatment of Native Americans, the state would have had the necessary tools to provide health care coverage for low-income individuals.

At the same time, the legislation would have provided $50 billion in funding to help stabilize the insurance market and make it more competitive so that consumers could have access to better and more affordable health insurance policies. Further, the bill would have phased in over seven years to make sure the states have a long adjustment window to ensure financial viability.

The Obamacare Repeal and Reconciliation Act would have repealed portions of Obamacare, while continuing Medicaid expansion and insurance premium support payments and giving Congress the time to enact a replacement.

None of these bills received sufficient support to pass.

While critics have used Congressional Budget Office numbers to criticize our reform efforts, it is important to understand how the CBO score works. The CBO score indicated that up to 16 million more people would be uninsured under the Health Care Freedom Act. This CBO estimate results from repeal of the mandates, meaning people would choose not to sign up for insurance. They would not lose access to insurance because the premium support payments, Medicaid and expanded Medicaid would have continued to remain in place on the same basis. In other words, insurance coverage would not have been “ripped away” from people as some opponents have claimed.

All along, I’ve said that health care reform will be a process, not one bill. We have worked diligently to get that process underway. We will continue those efforts and hope that Democrats will join us to make reforms to the health care system that will provide Americans with access to patient-centered health care and insurance at affordable rates.

John Hoeven is the senior U.S. senator from North Dakota.

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