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Health Care: A Personal Option

Sep 23, 2020 by AFP

Everyone should have access to the high-quality health care they need, when they need it, at a price they can afford.

In some ways, health care in America achieves those goals and does it well. The United States boasts some of the shortest surgery wait times and some of the best cancer survival rates in the world. And we remain the world’s leader in developing new life-saving therapies and cutting-edge technologies.

But American health care could be greatly improved. Despite its strengths, it can be complex, bureaucratic, and unaffordable for many. Too many families struggle to afford needed care and coverage. And tragically, many – even some seniors on Medicare – go bankrupt from high medical bills.

Despite these challenges, most Americans are relatively happy with their current arrangements. They are not calling for a government takeover of health care or the elimination of private insurance options. Instead, they support targeted changes to fix what’s broken and preserve what works.

These five reforms, we believe, would bring about the improvements Americans want and deserve:

  1. Expand access
  2. Reduce costs
  3. End negative surprises
  4. Protect the vulnerable
  5. Help people, not insurance companies

Our Vision

What do Americans want when it comes to health care? We want:

  • To see the doctor of our choice, conveniently and affordably.
  • Access to the most appropriate treatments.
  • Access to good insurance that meets our needs at an affordable rate.
  • To know how much our care will cost, up front, before we pay for it.
  • Safety nets that protect the vulnerable.

How can we achieve those goals? The best way is to remove barriers. Barriers between patients and medical professionals, between patients and needed therapies, and between inventors and life-saving medical breakthroughs.

Some people argue for a very different approach. They want a government takeover of health care. This simple “solution” (which goes by various names, such as “single payer,” “national health insurance,” “socialized medicine,” “Medicare for All,” and “a public option”) might sound appealing, but it cannot guarantee the basic protections people need.

People in countries with government-run health care typically endure bureaucratic rationing and long wait-lists due to unavoidable shortages of personnel, equipment, and therapies. And tragically, the burden of such rationing falls heaviest on the most vulnerable: the sick, the elderly, and people with chronic medical conditions. Access to a waiting list is not access to care.

Take Canada, for instance, where private health insurance is effectively outlawed. Health care is “free” there, yet patients pay for it in other, tragic ways. Canadians receive fewer cancer screenings than Americans do and have higher mortality rates for certain cancers. While Americans enjoy access to 89 percent of new drugs, Canadians only have access to about half, because their government deems most new drugs “too expensive.” The median wait time in Canada for an MRI scan is more than two months – to be treated by a specialist, more than five months. Canadians end up paying for their “free” care by being forced to endure needless suffering, lost income, and preventable death.

Even the “moderate” approach of a “public option” is a false hope. There is nothing “moderate” about it. In this approach, the government, instead of immediately abolishing private insurance companies, “competes” with them while also taxing and regulating them. You can guess what will happen. It ends in a government monopoly and thus in widespread disruption, cost hikes, and reduced access to care.

Instead of a “public option,” we need a personal option. Instead of “universal coverage” with inferior, government-run insurance, we need universal access to affordable, high-quality care.

  1. Expand Access

Expand HSAs. A Health Savings Account is a unique and powerful savings tool that helps families pay their out-of- pocket medical expenses tax-free. HSA owners enjoy the equivalent of a 15 to 40 percent discount each time they purchase a health care item or service, depending on their tax bracket. HSAs give patients greater control of their medical decisions, and studies show they help reduce health care costs.

Unfortunately, today only about 10 percent of Americans are able to have an HSA because account owners must buy a narrowly defined form of high-deductible health plan. By removing this needless restriction, we can allow all Americans to have an HSA. We should also increase HSA contribution limits and allow HSA funds to be used for more kinds of care and coverage (for example, direct medical care subscriptions that offer convenient, round-the-clock access to trusted doctors). Americans for Prosperity (AFP) supports legislation to expand HSAs, especially the Health Savings Accounts for All Act (S.4367 by Sen. Rand Paul), the gold standard of HSA expansion bills. AFP also supports the Pandemic Eradication and Enhanced Preparedness through Savings Act (H.R.7825 by Rep. Ken Buck) and the Personalized Care Act (S.3112 by Sen. Ted Cruz and H.R.5596 by Rep. Chip Roy), as well as a version of the latter bill that would only apply during the Covid-19 public health emergency: the Pandemic Health Care Access Act (S.3546 by Sen. Cruz and H.R.6338 by Rep. Ted Budd).

Strengthen HRAs. Congress should expand access to workplace, tax-free health reimbursement arrangements (HRAs), which, thanks to a recent federal regulation, enable employees to use money from their employer to buy private health insurance. This is a critical step toward leveling the tax playing-field so individuals can freely choose between employer-sponsored and private, portable insurance. Congress should enact legislation to protect this regulation, such as the AFP-supported Increasing Health Coverage through HRAs Act (H.R.5224 by Rep. Dan Bishop). Congress should also give HRA users even more money-saving options by allowing HRA funds to be used specifically to purchase short term renewable health insurance plans, which can be dramatically more affordable than traditional plans.

Promote telehealth. Studies show the use of telehealth – the remote delivery of medical care using digital telecommunications tools – reduces infection and hospitalization rates and saves money. Wider use of telehealth could unleash a digital health revolution and save lives, but alas, many insurers and health plans impose restrictions. For example, Medicare limits telehealth to certain narrowly defined rural areas and does not allow patients to use it

in the comfort of their own home. Congress should lift these and similar restrictions. AFP supports legislation to expand Medicare telehealth access, including the Telehealth Innovation and Improvement Act (S.773 by Sen. Cory Gardner and H.R.4013 by Rep. John Curtis) and the CONNECT for Health Care Act (H.R.4932 by Rep. Mike Thompson and S.2741 by Sen. Brian Schatz).

Repeal certificate-of-need laws. These laws require local government approval before private entities can invest in new hospitals, beds, and cutting-edge technology. Often, existing market participants have a veto over new entrants. Such protectionism harms patients and is never justified. AFP supports legislation that would repeal state and local CON laws, and supports similar federal bills, including the Creating Capacity for Communities in Need Act (S.3547 by Sen. Ted Cruz and H.R.7168 by Rep. Vincente Gonzalez) and the Increasing Hospital Capacity to Fight the Coronavirus Act (H.R.6336 by Rep. Dan Bishop).

Let nurses deliver the care they’re trained for. Many states prevent non-physician providers such as advanced practice registered nurses and physician assistants from practicing to the full scope of their training by requiring that they work under the supervision of a physician. AFP supports removing such impediments to competition. We support the Coronavirus Regulatory Repeal Act (S.3922 by Sen. Rand Paul and H.R.6691 by Rep. Chip Roy) would make various recent temporary Medicare changes, including waivers of certain physician supervision and signoff rules, permanent, subject to a special review process.

Let doctors and nurses practice across state lines. State licensure laws impede the ability of doctors and nurses to care for out- of-state patients, including via telehealth. Removing these barriers would greatly improve choice, competition, and the quality of care. Therefore, AFP supports state legislation to automatically recognize out-of-state health professional licenses.

Allow “truth in medicine.” The federal Food and Drug Administration (FDA) imposes a gag rule on drug manufacturers barring the sharing of scientific information with doctors about possible uses of drugs outside the current limits of the drugs’ labeling – even when such information is truthful, non-misleading, and potentially lifesaving. AFP supports removing this misguided restriction on free speech.

Speed up FDA drug approvals. On average it takes 10 years and $3 billion to bring a new drug to market. Some drugs are approved in the U.S. only many years after they were approved overseas. Patients suffer and die needlessly. We can reduce these excessive costs and needless delays without harm to patients by requiring FDA to recognize drugs and devices that have been approved by advanced countries we trust. AFP supports legislation to do this, especially the RESULTS Act (S.2161 by Sen. Ted Cruz and H.R.6258 by Rep. Chip Roy), the leading bill on this topic. AFP also supports a version of this bill, written by the same sponsors, that would apply only during the Covid-19 public health emergency: the RESULTS for Coronavirus Patients Act (S.3545 and H.R.6260).

Remove FDA barriers to diagnostic tests. In a pandemic or epidemic, widespread and frequent diagnostic testing is critical. Instead of FDA’s traditional, highly bottlenecked approach, we need a more nimble, decentralized oversight approach. AFP supports codifying FDA’s wise procedural waivers of the Covid-19 pandemic, such as enabling states to oversee diagnostic test deployment for infectious diseases and allowing private test developers to market their products immediately, rather than waiting for government review, in an emergency. AFP supports legislation to do this, including the Right to Test Act (S.3769 by Sen. Ted Cruz and H.R.7017 by Rep. Patrick McHenry).

  1. Reduce Costs

Reduce prescription drug prices. Consumers struggle with the high cost of drugs, but government price controls, which invariably lead to scarcity and bureaucratic rationing, are the wrong remedy. Instead, patients need sensible reforms that remove barriers to robust market competition. AFP supports legislation to do that, including key provisions of the Lower Costs More Cures Act (S.3129 by Sen. Mike Crapo and H.R.19 by Rep. Greg Walden).

Strengthen short term renewable health insurance plans.

Consumers deserve access to more affordable insurance options tailored to their needs. For this reason, Congress should expand access to short term renewable plans, which are typically 50 to 80 percent less expensive than traditional plans because they do not have to meet the Affordable Care Act’s onerous mandates. Unfortunately, about a dozen states ban the plans, while others over-regulate them. Federal legislation has been introduced to ensure that a future president cannot eliminate the plans, including the AFP-supported Health Coverage Choice Act (H.R.4811 by Rep. Andy Biggs) and Affordable Health Care Options Act (S.3821 by Sen. Kelly Loeffler).

Legalize association health plans. Congress should let individuals and businesses band together to buy affordable coverage at group rates. In 2018 the Labor Department tried to do this via regulation, but a federal judge blocked the regulation. AFP supports legislation to legalize AHPs, including the American Healthshare Plans Act (S.3610 by Sen. Rand Paul and H.R.6712 by Rep. John Curtis) and the Association Health Plans Act (S.1170 by Sen. Mike Enzi and H.R.2294 by Rep. Tim Walberg).

Regulate health insurance more sensibly. Consumers desperately need more affordable health insurance options. Misguided and onerous state and federal mandates are driving up premiums and deductibles and shrinking provider networks (the main cause of the recent surge in “surprise medical bills”). We should remove these harmful barriers while preserving protections for people with pre-existing conditions by sending the funding and mandates of the Affordable Care Act back to the states with certain requirements to ensure that people with high-cost medical conditions can obtain affordable coverage.

  1. End Negative Surprises

Promote price transparency through truth-in-advertising. In
no market are prices as invisible as they are in health care. Rarely can patients discover what their care will cost, up front, before they have to pay for it. The result? Excessive charges, unexpected bills, and massive waste. Restoring price transparency is vital to restoring markets in health care. But simply mandating the publication of fictitious list prices does not work and mandating the publication of privately negotiated rates violates contract rights. Instead, we can produce transparency naturally by enforcing anti-fraud rules and adopting the reforms outlined in the other sections of this plan.

  1. Protect the Vulnerable

Restore Medicaid to its original mission. Medicaid was never meant to be a middle-class entitlement that displaces private insurance options and busts the federal budget. Congress should simplify, streamline, and rationalize Medicaid to restore its original mission of being a safety net for the most vulnerable.

Modernize Medicare. Medicare is an expensive and, in many ways, outdated insurance product, and one that negatively distorts health care markets nationally. Congress should modernize and strengthen Medicare to give seniors more freedom and better access to doctors and therapies at lower cost. For starters, Congress should: 1) make it easier for seniors to “vote with their dollars” within Medicare by expanding their ability to choose a competitive private Medicare Advantage plan; 2) enact the Health Savings for Seniors Act (H.R.3796 by Rep. Ami Bera), which would allow seniors to contribute to HSAs and thus more easily afford cost-sharing expenses within Medicare and medical items and services that Medicare does not cover; and 3) enact the Retirement Freedom Act (S.1030 by Sen. Ted Cruz and H.R.2108 by Rep. Gary Palmer), which would allow seniors to “vote with their feet” and disenroll from Medicare without penalty.

  1. Help People, Not Insurance Companies

Health care exists for patients. Their well-being is paramount. That’s why AFP believes that, as a rule, government health care assistance should always go directly to individuals rather than to insurance companies or government bureaucracies.


Our health care system is in need of reforms that make the system work better for every American. But doubling down on the failed status quo through a government takeover would only make things worse. Instead of a “public option,” we need a personal option: a set of sensible, targeted reforms that fix what’s broken in our health care system and preserve what works. By removing barriers to affordable, high-quality care, we can make American health care the envy of the world.