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Replacing Obamacare: A Sleight of Hand

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Republicans finally have President Obama on the ropes.

In their fourth Congressional attempt to repeal the Affordable Care Act, the new Republican-dominated legislature attached a novel condition to their bill: an alternative. The last three times the indignant House took the ACA to task via a vote to repeal the law, opponents had the benefit of pointing out that, with the uninsured getting coverage and the online marketplaces learning from the mistakes made in the initial roll-out, Obamacare may actually be better than nothing.

So House Republicans have strategized, and incorporated a directive in their new challenge to the President's signature piece of legislation. A bundle of legislative committees were tagged in the new law with the responsibility to craft an alternative plan for healthcare reform.

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What might this bold new Republican plan look like?

Probably more than a little like the ACA.

Medicare Deja Vu

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The leading controversy of the ACA--and the one driving its legal challenge to the Supreme Court--centered on forcing Americans to purchase insurance under the threat of a fee (rebranded as a 'tax' following the Supreme Court decision). Critics have had a lot to say about the problems relating to the means--from the online marketplace to the Medicare and Medicaid incentives--by which the ACA expanded insurance enrollment.

Other features of the law, such as the host of incentives and targeted funding to expand healthcare access, have been less controversial along partisan lines. Quite the contrary--for the second year running, Republican-introduced legislation is in committee that would double-down on the notion that primary-care providers should be paid for preventive-care services.

H.R. 592, the clone of last year's H.R. 4190, was introduced once again by Rep. Brett Guthrie from Kentucky on January 28, with co-sponsorship from another Republican and two Democratic representatives. The purpose is simple: to allow pharmacists to receive Medicare reimbursement for their preventive-care services. Current rules restrict such payments to primary-care physicians; since pharmacists play a critical role in preventive medicine, the law would essentially allow them to receive their dues.

An Ounce of Prevention

The notion that care providers other than physicians can play a role in preventive care is not new. The ACA, aside from stretching the insurance umbrella, was designed around the idea that proactive medicine (that is, keeping people from getting sick to begin with) would save more money and reduce healthcare costs.

One of the leading obstacles to expanding this kind of care is demographics. The baby-boomer generation is entering its golden years. Not only does this mean more and more elderly patients with chronic conditions or other long-term-care needs, it also means aging doctors and nurses retiring and leaving a massive provider gap. Between the influx of patients and the decline in providers, there simply aren't enough workers to go around--and it is going to get worse as boomers continue to age, retire, and seek care.

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Relieving this pressure on physicians and hospitals is the idea that, paying non-physicians to provide preventive- and primary-care services gives patients more options and greater access to basic care. That is why the ACA directed funds toward RNs, among others. That is also why a bill that proposed the same kind of payment for pharmacist services--already a requirement under Medicare's Part D.

Not So Different After All

When Rep. Guthrie's bill hit the floor in the last Congress, it won the support of 123 co-sponsors--68 Democrats and 55 Republicans. By contrast, the latest vote to repeal the ACA was split almost precisely along party lines, with 239 Republicans for the change, and 186 Democrats against.

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Edgar Wilson is an Oregon native with a passion for cooking, trivia, and politics. He studied conflict resolution and international relations at Amherst College, and has split his time between New England and the Pacific Northwest ever since. He has (more...)

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