Opinion Pieces

Health Care: The HSA Solution

Human Events

Washington - Rep. Louie Gohmert , September 8, 2009
The current level of spending and growth in health care cost will soon bankrupt our nation, with the latest full year numbers showing that tax dollars spent in 2007 on Medicare grew to more than $430 billion, and almost $330 billion for Medicaid. That year, these programs cost the federal government an average of $9,200 in tax dollars for every household in America, and that number increases daily.

This is unsustainable. Any reform must guarantee that patients have access to the treatment they need, when they need it, with the doctor they choose, at a price that is transparent, affordable, and covered.

That is exactly what the Patient-Controlled Healthcare Protection bill does. For people currently on Medicare, Medicaid, SCHIP or any combination, they will for the first time ever gain complete control and complete coverage through high deductible insurance with a personalized Health Savings Account (HSA) to cover the entire deductible.
The structure of the plan leaves health care decisions between patients and their doctors while getting both government and insurance autocrats out of the way. Like many people, I currently have an HSA, but the insurance company has far too much control over health care decisions and the doctors I use. Insurance companies long ago got out of the business of insuring and into the business of micro-managing health care decisions. Insurance was originally intended to insure against potential catastrophic illness or accident and normally required a small premium to protect against such unknowable future events.

It is time to put insurers back in the business of insuring, and that is what the Patient-Controlled Healthcare Protection will do. An updated version of the plan expected to be introduced this week also ensures that our most vulnerable and needy citizens are protected and covered.

Under the bill, everyone eligible for Medicare, Medicaid, SCHIP or any combination has the option each year of having the federal government purchase private insurance with a high deductible, while also funding cash into a Health Savings Account that covers the deductible. For any household containing one person currently covered by one of the government healthcare programs, that person will receive $2,500 deposited into an individual HSA under their control, while any household containing more than one covered under these programs will be provided with $3,500 deposited into their household HSA.

The HSA will be accessed by a debit card coded so that it may only be used for health care purchases. Additionally, the bill provides incentives for employers to provide exactly the same kind of coverage for their employees. Employers may provide pretax contributions to employees for deposit and use in an HSA of the employee's choice as well as for a catastrophic health insurance plan. Such contributions and purchases are business expenses to the employer and non-taxable to the employee. The self-employed have the same opportunity and advantage. The bill also mandates that policies will be owned by the employee, making the policy fully portable wherever and whenever an employee were to go.

Also, there is no more using or losing the amount in the HSA by the end of the year. Any unused amounts remain in the account, allowing it to grow. And there are no limits on the pretax amounts that may be put into such HSAs. To help make insurance policies more competitive, insurance companies licensed to do business in the United States may offer policies across state lines, which has long been called for by Rep. John Shadegg (R-Ariz.).

For some conservatives, the new alternative to the government programs may seem like another government giveaway, but it will actually cost less than what is currently being spent to cover Medicare, Medicaid, and SCHIP. Even further savings for the government should come from the fact that most young people in their twenties and thirties can accumulate major amounts of cash in their HSAs by the time the reach Medicare eligible age. This should eventually lead to fewer and fewer people even needing or wanting government assistance.

It all puts the country on a correction course to actually save increasing amounts each year, all while giving patients the control and coverage we have long desired.  In order to increase accessibility to the desirable new form of HSA, two or more individuals living in the same household may establish an HSA for their household simply by signing an agreement regarding how the HSA will be divided should someone leave the household.  It should also be noted that once money is paid into the HSA, it may only be used for healthcare purposes, though it may be gifted to the HSAs of children, relatives or heirs with no tax consequence.

When the amount in the HSA exceeds the deductible, the owner may choose to raise the deductible or even invest it in order to earn interest or premiums from reliable sources such as government bonds. A separate type of federal inflation-proof Treasury bond may be created specifically for such an investment, thereby guaranteeing that as long as the United States exists, so does your healthcare savings. To encourage seniors to avoid spending the account on unnecessary healthcare, ten percent of any excess of the government-provided annual HSA amount may be withdrawn at the end of the year tax-free.

This plan provides patients both choices and security like never before, allowing the selection of the doctor of you choose without an insurance company telling you a physician is not on your plan.  Additionally, the bill puts an end to “gatekeepers” who get to tell you whether or not you may visit a particular specialist. If you want to go directly to a dermatologist for a skin problem, that’s where you go. If you want to see an orthopedic specialist for a bone problem, that is who you see.  Doctors will be free to diagnose, advise, and treat in consultation with patients without having to consult the government or insurance company to see if giving you what the doctor thinks you need meets bureaucratic approval.

TRANSPARENCY of health care costs is another critical component of this bill. Health care providers must provide a list of charges for procedures, treatments, or expenses to any potential patient, as well as the prices that are charged to other entities. Free market principles should prevent a government from telling doctors or hospitals what to charge, but they also require that everyone gets to know exactly what a health care provider charges so the patients make informed decisions to get the best value for the best treatment. This will bring to light the actual price of health care paid by insurance companies, which is only a fraction of the obscure and exponentially inflated prices we see.  

This plan also prohibits insurance companies from cherry-picking only the healthiest and least risky Americans and denying those who need health care most. There would be no cancellations for pre-existing conditions or problems that arise. There will be some necessary cost-sharing aspect in order for this requirement to be met. But it is time to make that the kind of coverage we have.  

Another problem of great concern is that terrorist cells have reportedly discerned that they can simply send pregnant women to the United States on travel visas just in time to have babies. One lady recently bragged to a member of Congress sitting by her on a plane from Newark to the Middle East (not knowing who he was) that another grandchild would be born in the United States by the end of August as their daughter would visit America right before the baby was born. She also mentioned during the long flight that her husband and her son-in-law were both members of Hamas. She explained how nice it was to bring children into their family who are American citizens. She added that the best part was that her daughter could fly back to their country and not even have to pay anything.  

For the sake of our national and financial security, this cannot continue. Because the risk of excessive health care costs bankrupting our country is not acceptable, it is a matter of national security that our system not be overwhelmed by immigrants receiving taxpayer-funded care. Therefore, anyone seeking to travel or immigrate to the United States must provide proof that they will have full health care coverage while here. Such coverage may be through a sponsoring employer or a resident in whose household the immigrant intends to reside. Otherwise, a visa will not be granted. If health care coverage ceases while the migrant is here, then the visa does too.

Employers needing migrant workers could set up their own migrant worker coverage or households could allow an incoming immigrant coverage under their plan, but there must be coverage. We do believe in following the rule of law which currently requires that anyone needing healthcare must have it provided, regardless of legal status, so we follow the law and provide the care.

For the sake of this nation's survival and progress, we cannot afford a government-takeover of healthcare -- especially when there is a much simpler, more viable option. It is imperative that we seek true health care reform that puts the patient first by protecting your vital relationship with your physician.  

The Patient-Controlled Healthcare Protection Plan will create a fiscally responsible, genuinely patient-centered approach to health care, which is what Americans expect, demand, and deserve. It eliminates the obstacles between you and your doctor. No insurance company, HMO, or government bureaucrat will have the power to tell you whether you can receive health care. This plan gives patients complete control and complete coverage that is affordable and accessible. Medicine will once again be about the patient's needs and the doctor's diagnosis, with true competition like we haven’t had in a very long time, if ever.

Louie Gohmert, a Republican, has represented the First Congressional District of Texas in the U.S. House of Representatives since 2005.