Health Insurance Roulette, Straight from P2025

Over the weekend, 47 made another of his proclamations from the golf course of his gilded private club:

I am recommending to Senate Republicans that the Hundreds of Billions of Dollars currently being sent to money sucking Insurance Companies in order to save the bad Healthcare provided by ObamaCare, BE SENT DIRECTLY TO THE PEOPLE SO THAT THEY CAN PURCHASE THEIR OWN, MUCH BETTER, HEALTHCARE,” Trump wrote. (SOURCE: The Guardian)

This is essentially what Republicans attempted in 2017 when they unsuccessfully tried to repeal the ACA (also known as Obamacare.)

But it is also what Project 2025 outlined.

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The Republican healthcare plan they refuse to publicly outline is fully explained in Project 2025 (which is why they refuse to explain it every time someone asks for details.)

So let’s review the Republican Project 2025 Healthcare Plan in their own words.

Project 2025 page 469

Remove barriers to direct primary care. Direct primary care (DPC) is an innovative health care delivery model in which doctors contract directly with patients for their care on a subscription basis regardless of how or where the care is provided. The DPC model is improving patient access, driving higher quality and lower cost, and strengthening the doctor– patient relationship. DPC has faced many challenges from government policymakers, including overly exuberant attempts at regulation and misclassification. Changes should clarify that DPC’s fixed fee for care does not constitute insurance in the context of health savings accounts.

Only the wealthy or well-off can afford Direct Primary Care. It can also be attractive to young, healthy people, which would entice more of them out of the ACA pool and increase costs for everyone remaining. Of course, young, healthy people eventually become older and less healthy, but I digress….

Project 2025, page 469

Revisit the No Surprises Act on surprise medical billing. The No Surprises Act protected consumers against balance bills, but it also established a deeply flawed system for resolving payment disputes between insurers and providers. This government-mandated dispute resolution process has sown confusion among arbiters and regulators as judges have sought to ascertain its meaning. The No Surprises Act should scrap the dispute resolution process in favor of a truth-in-advertising approach that will protect consumers and free doctors, insurers, and arbiters from confused and conflicting standards for resolving disputes that the disputing parties can best resolve themselves.

Private equity is buying up more hospitals every day. According to Private Equity Hospital Tracker, they have invested more than $1 trillion into US hospitals in the past decade. They HATE HATE HATE being forced to avoid Surprise Bills, because it has historically been one of their most profitable revenue streams. This policy position makes money for Private Equity billionaires and shafts everyone else.

Project 2025, page 469

Facilitate the development of shared savings and reference pricing plan options. Under traditional insurance, patients who choose lower-cost care do not benefit financially from that choice. Barriers to rewarding patients for cost-saving decisions should be removed. CMS should ensure that shared savings and reference pricing models that reward consumers are permitted.

Cost-saving decisions is code for “foregoing care,” “stretching prescriptions,” and “ignoring symptoms that could indicate a substantial health problem.” Oh, and the premiums and deductibles would still be obscene.

Project 2025, page 469 – 470

Separate the subsidized ACA exchange market from the non-subsidized insurance market. The Affordable Care Act has made insurance more expensive and less competitive, and the ACA subsidy scheme simply masks these impacts. To make health insurance coverage more affordable for those who are without government subsidies, CMS should develop a plan to separate the non-subsidized insurance market from the subsidized market, giving the non-subsidized market regulatory relief from the costly ACA regulatory mandates.

Republicans are allowing ACA tax credits to expire to fulfill this Project 2025 goal. The ACA insurance market will now be the non-subsidized insurance market, with the 25 – 100% premium increases that causes.

Project 2025, page 470

Congress should build on the Trump Administration’s efforts to expand choices for small businesses and workers, both in and out of the exchanges, by codifying an expansion of association health plans, short-term health plans, and health reimbursement arrangements (including individual coverage HRAs). CCIIO should also work with the Treasury Department and the Office of Management and Budget (OMB) to give consumers more flexibility with their health care dollars through expanded access to health savings accounts.

This was essentially what 47 called for in his UnTruth social post. Let’s give people a one-time payment to purchase health insurance on the open market, without ACA regulations (which include no exclusions for pre-existing conditions and manageable premiums for people with health problems.) And every year thereafter, you’re on your own, Americans.

Project 2025 theocrats also buried this gem on page 697:

To reduce this tax bias against wages (as opposed to employee benefits), the next Administration should set a meaningful cap (no higher than $12,000 per year per full-time equivalent employee—and preferably lower) on untaxed benefits that employers can claim as deductions…Only a percentage of Health Savings Accounts (HSA) contributions (which are not taxed upon withdrawal) should count toward the limitation. The limitation on benefit deductions should not be indexed to increase with inflation. Employers should also be denied deductions for health insurance and other benefits provided to employee dependents if the dependents are aged 23 or older.

Republicans don’t want to incentivize employers to provide health insurance. Out of one side of their mouths, they say Americans should be given a one-time payment to purchase their own insurance plans; out of the other side of their mouths, they say employers shouldn’t be able to exempt Health Savings Account withholdings that would enable Americans to save more money for insurance.

They also want to force dependents age 23 and older to “get out of their basements and work” by making it impossible for Mommy and Daddy to include them on their work-based health plans.

I’ve put a lot of technical Project 2025 jargon in today’s newsletter. Let me break down the Republican Health Plan for you, as outlined in Project 2025:

• Only the rich will be able to afford effective healthcare.

• Private equity billionaires will again profit from Surprise Billing without any means to challenge them. There will also be no limit on how many hospitals they can own.

• Americans should be rewarded for ignoring health problems, avoiding care, and rationing prescription drugs via slightly less astronomical insurance policies with the same high deductibles and co-pays.

• All ACA policies will now be private insurance plans that don’t have to follow ‘pesky’ ACA regulations. That means 1. Exclusions for pre-existing conditions; 2. Unaffordable premiums on everything else because of pre-existing conditions; 3. Healthy people will forego health insurance, which will drive up costs for everyone else. (I don’t know how to make Americans understand that insuring healthy people drives costs down for everyone else. It spreads risk around the pool and helps everyone afford access.)

• Throw a one-time pittance at Americans to sock away in health savings accounts, and leave them on their own to navigate unregulated for-profit healthcare and insurance plans with said pittance.

• Abolish most pre-tax deductions for employer healthcare costs.

It’s hard for Americans to know what to demand if they haven’t experienced another healthcare system. Tomorrow, let’s talk about what US healthcare COULD look like by covering healthcare in other developed countries.

I’m going to be really candid about my experiences and the cost involved. I hope other readers will share, too.

I hope to give Americans persuasive talking points to use in their communities AND hammer politicians with a demand for universal healthcare. Join us.