October 13, 2015

Event:            Governor Bush to deliver speech on his policy to repeal and replace Obamacare
Location:      New Hampshire Institute of Politics
100 Saint Anselm Drive
Manchester, NH 03102
Start Time:     10:00 AM EDT

The Conservative Plan for 21st Century Health

ObamaCare is a government takeover of more than one-sixth of the American economy, and it epitomizes why Americans are so fed up with Washington. To win on repeal, conservatives must unite  around a vision of health care for the future – one that enables transformational innovation. Governor Bush’s plan would repeal ObamaCare and accomplish three things:

1. Promote innovation
2. Lower costs
3. Return power to states

Here is how Governor Bush would repeal and replace ObamaCare:

1. Promote innovation in health care

Health care costs grow faster than any other sector of the economy and innovation lags. Why? Washington over-regulation in health care creates high barriers to entry, adds excessive costs, fosters excessive complexity and impedes innovation. Governor Bush will:

  • Modernize the Food and Drug Administration’s regulatory morass and increase funding and accountability at the National Institutes of Health
  • Promote private sector leadership of health information technology adoption and enable better access to patient de-identified Medicare and Medicaid claims data
  • Establish a comprehensive review of regulatory barriers to health innovation

2. Lower costs and enable portable, secure coverage for all Americans

Until health care is oriented around consumers, providers and innovation, Americans will not get better value and results out of the health care system. In addition, coverage options must reflect a modern, 21st century workforce where workers frequently switch jobs or start new businesses and need the security of portable coverage.

It is critical to have a well-functioning individual market side-by-side with a strong employer-sponsored coverage market. The employer health insurance market represents a strong and innovative coverage platform for 154 million Americans. To improve coverage, Governor Bush will:

  • Provide a tax credit for the purchase of affordable, portable health plans that protect Americans from high-cost medical events
  • Increase contribution limits and uses for Health Savings Accounts (HSAs) to help with out-of-pocket costs
  • Facilitate transparency on costs and outcomes
  • Cap the employer tax exclusion to lower insurance premiums
  • Allow employers to use financial incentives to encourage wellness programs
  • Enable small businesses to make tax-free contributions to their workers’ individual, portable health plans

3. Take health care control out of Washington and return it to states

States should have responsibility, freedom and accountability to make their individual insurance markets more competitive, enhance access to care and design solutions for vulnerable Americans. Instead of Washington standardization, this approach emphasizes transparent outcome standards. States will have streamlined, capped federal funding and be responsible for meeting transparent metrics to:

  • Make their insurance markets more competitive. This will include enabling access to affordable, catastrophic plans in their states; a continuous coverage guarantee for individuals with pre-existing conditions; access to affordable care and improved health outcomes in their state; lower health care cost growth, including medical liability reform; and a transition plan for the 17 million individuals entangled in ObamaCare.
  • Strengthen the health care safety net. To achieve this, states may use a number of strategies: individualized, community-based benefit designs; coordinated care for individuals with behavioral health conditions and the disabled; tailored care delivery to reflect the diversity of state populations; personalized care solutions for high-risk individuals with proven data analytics; work requirements for able-bodied individuals; premium assistance for individual and employer-provided coverage; and consolidated funding from various programs to better coordinate care.

October 13, 2015

Backgrounder: Health Care Plan

America’s health care system has long been an anachronism.  It works by payment rules, regulations and tax policies that date back to the 1940s and 1960s and have made little sense for decades.  No wonder it is expensive, complex and inaccessible.  And ObamaCare has only further entrenched and worsened its problems.  It is time to introduce health care to the 21st century and enable the possibilities of 2025.  Governor Bush believes transformational solutions should accomplish three goals:

  • Promote innovation
  • Lower costs
  • Return power to states
Change and disruptive innovation happen across the American economy. Medicine itself is modernizing, despite an unusual number of barriers.  Smart phones make it possible to video chat with doctors and caregivers.  Precision medicine can personalize and more effectively treat cancer and other diseases.  3D printers can turn out replacement blood vessels, liver cells and heart valves.  Unfortunately, Washington has been micromanaging and holding back this progress, and preventing Americans from fully benefitting from it.  Instead, it should put itself on the side of transformational innovation driven by the ingenuity of Americans.

This would not only help medicine make us healthier, it is also the only strategy to bring down health care costs for hard-working Americans who see their wages suppressed, their premiums rise or their access to care prove inadequate when it matters most.

Unfortunately, ObamaCare doubled down on the 1940s and 1960s-era system.  Instead of promoting innovation, it regulates and taxes innovation.  Instead of empowering problem-solvers in the real world, it embodies the liberal ideal that Washington needs to and can solve every problem.

ObamaCare enabled Washington control of more than one-sixth of the American economy, and it confiscated citizens’ ability to select a health plan, a hospital and even a doctor.  It epitomizes why Americans are so fed up with Washington.  Government inserts itself into our daily lives, fails to keep its promises, fails to recognize unintended consequences, spends trillions of dollars the country does not have, disrupts the lives of millions of Americans and leaves many worse off.  Americans are frustrated – and they have a right to be.

American families are still facing massive premium increases. American workers still cannot get the hours they need at work to make ends meet.  Four out of five Americans are now worse off under ObamaCare. By some measures, ObamaCare increased the average financial strain at every income level. While millions now have a Medicaid benefits card, they do not have coverage that gives them reliable access to care when they need it.  And even after 10 years and ObamaCare’s $1.7 trillion in spending, 27 million will still be left uninsured. With Americans still suffering, the country cannot give up.

ObamaCare must be repealed and replaced.  To position American health care to make the most of the potential of transformational innovation, policy solutions should go even further to stop the damage Washington central planners have caused for decades.  Solutions should ensure that health care is centered on individuals, the consumers, and that the health care system benefits from the innovation that will make it more accessible, convenient, personal and affordable.  Some say the problem is that American health care gives the private sector too great a role, but the real story is that Washington intervention holds back value creation in the $3.1 trillion health sector.

Here are just three examples of how central planners impede value and access in America’s health care system.  First, 1940s-era wage controls led to favorable tax treatment of employer-sponsored health benefits, which biases employer health coverage over individual health coverage and biases insurance over out-of-pocket spending.  Second, Medicare and Medicaid fee-for-service programs in the 1960s implemented price controls across the system.  This top-down approach drowns providers in regulations, mandates and shortsighted reimbursement cuts and leaves little opportunity for them to design more efficient and effective strategies to deliver care to seniors and the vulnerable.  Instead of focusing on outcomes and value, providers see incentives to focus on volume.  Third, government mandates and taxes – with ObamaCare representing the latest assault – force Americans to buy expensive products with benefits they do not want and may never need.  Not only does this intervention deprive individuals of the right to buy policies that fit their needs, it limits competition and innovative care options.

As president of the United States, Jeb Bush will make fixing the broken health care system one of his top priorities.  He will work with Congress to repeal and replace ObamaCare.

Governor Bush’s reforms will get Washington out of the way and empower patients with more choices, security and control over their health care decisions.  These reforms will not only lower the costs of care, they will substantially lower federal spending.  They will enable a modern system that is convenient, affordable, accessible and results-oriented.

How Governor Bush’s plan will help Americans

Economy: Repealing ObamaCare will add 0.7% to the American economy over five years. Repealing ObamaCare is an important part of Governor Bush’s plan to enable high, sustained economic growth leading to 19 million new jobs and rising middle-class incomes.

Workers: High health care costs suppress worker wages by 2.3%.  ObamaCare has reduced the aggregate number of hours worked by 1.5%, and taken four million full-time equivalent jobs out of the economy. Governor Bush’s plan will repeal ObamaCare and address the root causes of health care costs, and enable employers and workers to balance good benefits with fair wages.

Small businesses: ObamaCare has hit small businesses with higher costs and increased complexity.  Governor Bush’s plan will address the root causes of health care costs and give small businesses the option to make tax-free contributions to portable health coverage for their employees.

Middle-class Americans: ObamaCare created huge new subsidies for low-income Americans, but it left middle-income Americans facing higher premiums and higher out-of-pocket costs. Governor Bush will give individuals without an offer of job-based coverage a tax credit, regardless of income, to help cover the cost of plans that provide preventive care and comprehensive protection for high-cost medical events.  In addition, Governor Bush’s plan will give middle-class Americans help with out-of-pocket costs through enhanced health savings accounts.

Individuals who rely on Medicaid: Medicaid isn’t delivering patients the results they deserve.  For example, children on Medicaid end up using the emergency room as a doctor’s office more than uninsured children. Governor Bush’s plan will offer Medicaid patients more advanced care and better health outcomes.

Individuals with pre-existing conditions: ObamaCare’s centrally-planned approach has not worked.  Governor Bush’s plan will guarantee access to care for individuals with pre-existing conditions who switch to a new insurance company or move to another state.

States: Rather than crowd out innovation with Washington’s myriad regulations that ObamaCare compounded, Governor Bush will give states the freedom and accountability they need to make their insurance markets more competitive and to improve care for their most vulnerable citizens.

Promote innovation in health care

Medical research has identified the molecular causes of roughly 4,000 human diseases, but treatments only currently exist for approximately 250. Alzheimer’s causes suffering for seniors and their families, it is the sixth leading cause of death in America and it costs the nation $226 billion each year. Yet, Alzheimer’s cannot be prevented, cured or slowed. Breast cancer is still the most common cause of cancer in women, and it kills more than 41,100 women each year. It should not cost $1.2 billion to $2.6 billion nor take 12 to 15 years to advance a medicine from discovery to patients, but that is the case under the Food and Drug Administration’s (FDA) current regulatory mess. The National Institutes of Health (NIH) plays a critical role in developing basic science for new cures, but it lacks the resources to fund the most promising research.  Right now America has the highest corporate tax rate in the world, which discourages innovative companies from basing their work in America. (Governor Bush addresses this issue in his plan to grow the American economy and reform the tax code.) If the country is going to win the battle against devastating diseases, a multi-faceted strategy is needed.  The country’s entire medical ecosystem must be committed.  The government must do its part, but advances will be led by the creativity and courage of America’s scientists, care providers and innovators.

American entrepreneurs have achieved disruptive innovations that improve our lives, strengthen our economy and reduce the cost of living.  Think of Uber, smart phones, Twitter and Facebook.  These innovations radically increase efficiency and lower costs.  However, health care costs grow faster than any other sector of the economy and innovation lags.  Why?  Government over-regulation in health care creates high barriers to entry, adds excessive costs, fosters excessive complexity and impedes innovation.  When the government tries to “promote” health innovation, it impedes health innovation.  For example, the government spent more than $30 billion on federally-approved health information technology (IT) for physicians and hospitals, but one hospital system still cannot share patient information with another to coordinate care. And the IT systems are so complex that physicians spend less time with patients.

To fight disease and promote a culture of innovation in America, Governor Bush would adopt a multi-faceted strategy to enable the private sector to drive transformational change.

Modernize the FDA regulatory approach: Modernize the tools that the FDA uses to make scientific decisions, including biomarkers, patient-reported clinical outcomes and real-world data; accelerate clinical trials by utilizing patient data as it accumulates, rather than rigid predetermined timelines, to continuously modify and improve studies; allow manufacturers to share truthful, non-misleading scientific information and peer-reviewed clinical data with physicians and patients; and ensure that the FDA is adequately resourced to make timely approvals of safe and effective innovator and generic drugs.

Increase funding for the NIH: Increase NIH funding for research and require the Director of the NIH to submit a more robust strategic plan and biennial report on progress toward top research priorities such as Alzheimer’s disease, breast cancer, autism and precision medicine.  The strategic plan will need the buy-in from researchers across the country to ensure research is targeted and coordinated.  The strategic plan should set specific and lofty goals for Alzheimer’s, breast cancer and autism.  Even as investing in the NIH is critical, scarce resources do not need to fund studies on rabbit massages, how Buddhism explains the science of meditation and smartphone games to empower parents in vegetable-eating negotiations with their children. The NIH Director would also report publicly on efforts to eliminate unnecessary, duplicative research so that priorities have the resources to succeed.

Promote private sector leadership of health information technology adoption: Lead private sector collaboration, rather than government mandates, to establish national standards for electronic health record features and data interoperability; eliminate government mandates and penalties for health care providers who do not use government-approved electronic health records; protect health information from hackers and cyber attacks; and enable patient ownership of their medical history and records.  Individuals should have access to their longitudinal medical records, which will help providers offer more personalized and timely treatments for individuals.

Release patient de-identified Medicare and Medicaid data: Medicare and Medicaid patient de-identified claims data would be made more broadly available for commercial purposes in its original form (it is currently made available in processed forms).  This would allow entrepreneurs to use the biggest clinical data repository in the country to make health care more efficient and unlock quality and cost information for consumers.  For instance, entrepreneurs could evaluate the value and benefits of various treatments much more easily.

Establish a review of regulatory barriers to innovation: As outlined in Governor Bush’s regulatory reform agenda, he will establish an independent commission to conduct a regulatory spring-cleaning.  As part of this initiative, the commission would undertake a top-to-bottom review of federal regulations that impede access to higher-quality and lower-cost health innovations.

Lower costs and enable portable, secure coverage for all Americans

America spends twice as much as other industrialized countries on health care as a share of our economy. At least in part, this has to do with the perverse incentives federal policy creates for excessive spending throughout the system.  The tax treatment of health insurance is one good example.  Following World War II, the Internal Revenue Service granted favorable tax treatment to health insurance offered through businesses (an indirect response to wage controls during the war).  While the employer-based system offers significant benefits (and should be protected), the tax treatment favors upfront premium payments over out-of-pocket use-based payments, such as deductibles and co-pays.  This system has distorted the meaning of “insurance” in health care – promoting high-premium, pre-payment over value-driven insurance.  Instead of protecting against high-cost events like insurance does in most sectors, third parties in health care pay the bills for common, low-cost procedures.  This results in a lack of basic price signals.  Consumers do not pay the bills for most of the medical services they receive so providers are not directly accountable to them for value.  Furthermore, insurance companies and the government control how care is delivered and how much to pay for it, leaving little opportunity for doctors, hospitals and entrepreneurs to design innovative solutions to improve value.  Until health care is oriented around consumers, providers and innovation, Americans will not get better value and results out of the health care system.

A well-functioning, portable individual market is critical to meeting the needs of a 21st century workforce.  At the same time, employer-sponsored health insurance represents a strong coverage platform for 154 million Americans – the largest source of private coverage. This market has recently yielded innovations in health care – despite ObamaCare.  For example, defined contributions to private exchanges use robust competition to give workers real choices, responsibility and ownership of their health plans.  Employers and workers should have the tools they need to lower health care costs and realize higher wages.

To lower costs and create portable, secure health coverage for all Americans, Governor Bush would:

Provide a tax credit to those who do not have employer coverage: Individuals who do not get coverage through their employer should also get a tax break on their individual health insurance purchase.  Governor Bush would make available an advanceable, refundable tax credit for health care to those individuals as a matter of fairness.  The value of this credit would:

  • Be based on the average tax benefit that workers who get coverage through their jobs enjoy;
  • Help Americans access a basic level of preventive benefits and protect them from losing their life savings over a major medical event;
  • Be adjusted by age (so that it is more valuable for older Americans who may face higher premiums); and
  • Grow with inflation each year.
  • This would facilitate more portable and secure coverage over time.  The credit would be available to Americans under age 65, regardless of income, who do not have an offer of employer-sponsored insurance.  Instead of ObamaCare subsidies that go to insurance companies, these tax credits would go directly to individuals.  Whatever portion of the credit is not used to cover insurance premiums could be deposited into a Health Savings Account (HSA).  States would have the resources to supplement the value of the credit for low-income and vulnerable Americans.

    Facilitate transparency on costs and outcomes: As consumers control more of their own health care decisions, they deserve better transparency about the value of their care.  Governor Bush proposes transparency standards so that consumers have access to key information on price, outcomes and performance.  For example, Florida has a website that allows consumers to compare charges and lengths of stay for hospitals across the state. This would include making simple information available about the physician and hospital networks available in insurance policies – before individuals sign up for coverage.

    Allow employers to give financial incentives to employees who make healthy lifestyle choices: Employers offer health care benefits to more than 154 million Americans and are using innovative strategies to identify chronic conditions early and treat them in order to improve health and reduce unnecessary costs.  This is something that should be protected.  However, complicated and conflicting new government regulations are disrupting the ability of employers to offer common-sense financial incentives to reward healthy behaviors.  Governor Bush would make it clear that offering a reward for healthy behaviors can be done.  This would free employers to design health promotion and chronic disease management programs that have shown promise in helping employees lead longer, healthier lives.

    Allow small businesses to make tax-free contributions to individual health plans: Small businesses that cannot afford to provide insurance now cannot make a tax-free contribution to health plans that their employees purchase in the individual market without facing huge penalties.  Governor Bush would enable employers to make tax-free contributions to Health Reimbursement Accounts or HSAs so that their employees could purchase portable, individual market insurance policies.  (For this purpose, the contribution limit for an HSA would be higher than $6,550.)  This would allow small businesses to help their employees obtain health benefits, if they cannot afford the costs or complexity of offering the policy itself.

    Cap the employer tax exclusion: Governor Bush would allow individuals a $12,000 ($30,000 for family plans) tax break on the value of their health insurance obtained through their employers (the value of the cap would grow with inflation each year).  This will encourage employers to offer lower-cost plans, but also allows employees to choose the benefits that best suit their needs.  This would replace ObamaCare’s complex and onerous “40% tax,” which forces employers to arbitrarily reduce benefits to avoid the tax and thus limit the benefits employees may want and need.  Even economists on the left believe that this policy would reduce spending without harming health outcomes. Further, this policy would allow employers and employees to balance the need for good benefits and increased wages.

Take health care control out of Washington and return it to states

    ObamaCare included unprecedented and costly federal regulation of state insurance markets.  For instance, individual market plans must comply with ObamaCare’s costly “essential health benefits” mandates.  In addition, states have to comply with a litany of rules in operating their low-income health programs and undergo a lengthy waiver process if they want to make innovative changes to improve care.  Different rules for ObamaCare, Medicaid and the Children’s Health Insurance Program make state approaches to vulnerable populations uncoordinated and cumbersome.

    The most responsive and effective care is best delivered locally.  Patients, physicians, nurses, therapists and other health care providers live, practice, treat and collaborate in communities of care.  Thus, for states to meet the needs of all its citizens, states must have responsibility to make their individual insurance markets more competitive, enhance access to care and enable community-based solutions for low-income and vulnerable Americans.  Instead of Washington standardization, this emphasizes transparent outcome standards.

    Instead of multiple federal funding streams and sets of rules, states would present a plan to receive comprehensive and capped federal allotments.  This funding could be used to provide affordable care for individuals with pre-existing conditions, the vulnerable and low-income populations.  In return for this streamlined federal funding, states would be responsible to meet transparent metrics.

    To ensure states have the resources, ability and accountability to implement local solutions, Governor Bush would:

    Restore state regulation of competitive insurance markets: States receiving federal funding would have to meet the following metrics:

    • Reform their insurance markets and allow insurers to offer an affordable, catastrophic plan. Individuals would be free to choose plans with richer benefit designs, but this reform would give that choice back to individuals to select the plan that meets their needs. This would enable a new market where insurers could offer plans with premiums equal to the newly-created tax credit, and therefore with no upfront out-of-pocket costs for individuals – allowing everyone to afford coverage that would protect them against high-cost medical events.
    • Ensure access to affordable policies for individuals with pre-existing conditions. States would be held accountable to ensure access for individuals with pre-existing conditions. Such arrangements could require insurers to issue coverage to those who have maintained continuous coverage, establish well-funded high-risk pools, establish reinsurance arrangements or provide for risk adjustment among insurers who sell in the states.  The federal government would hold states accountable for results and could provide technical assistance for a range of approaches to achieve the results.  Until states implement a workable solution, there will be a federal continuous coverage protection.  If an individual has maintained health insurance, they cannot be denied coverage when moving to a new state or changing insurance.
    • Ensure access to affordable health care. States would report on access to care, including catastrophic coverage or population health outcomes. This would pave the way for provider-led care models, such as local hospitals or physicians offering primary care clinics and medical homes.  (Federal funding could not be used for a Medicaid fee-for-service expansion.)
    • Develop an action plan to reduce the growth of health care costs. States would need to develop an evidence-based action plan to address costs under their control, such as medical liability reforms or reforming payment models to focus on outcomes.
    • Develop a transition plan for the more than 17 million low-income individuals entangled in ObamaCare. For example, states could supplement the new tax credit so that low-income individuals have a fully funded HSA to meet all of their out-of-pocket costs.
    • Create accountability for better care and outcomes for low-income and the vulnerable:

    • The Medicaid program today may offer a benefits card to enrollees, but it does not achieve the health outcomes that vulnerable patients need or provide reliable access to physicians.  The Oregon Health Insurance Experiment found that Medicaid eligibility made little difference in health outcomes. This failure is unacceptable.  During the next president’s first term, the country will spend more than $700 billion a year on Medicaid, and Americans must demand results for their fellow citizens. As a condition of funding under this proposal, states would have the resources and tools to focus on population health outcomes.  Rather than all of Medicaid’s bureaucratic rules and regulations, states could use the capped allotments to implement solutions such as:

      • Premium assistance for low-income individuals around the new federal tax credit for low-income individuals
      • Individualized, community-based and innovative benefit designs (e.g., value-based insurance designs tailored for high-risk individuals, expanded primary care, consumer-driven benefit designs and incentives for healthy behavior)
      • Coordinated care for individuals with behavioral health conditions and the disabled
      • Tailored care delivery to reflect the diversity of state populations
      • Personalized care management solutions for high-risk, high-need individuals, by leveraging proven data analytics and information tools
      • Work requirements for able-bodied individuals
      • Outcomes transparency and value-based payment designs
      • Blended funding from various programs to better coordinate care (e.g., child welfare and dually-eligible populations)
      • This policy would not regulate the approaches states decide to take, but it would hold states accountable for outcomes since they are receiving federal funding.  This reflects requests from a majority of the nation’s governors as they seek to provide affordable, high-quality care for their most vulnerable citizens. States would receive a single allotment, based on the number and risk profiles of vulnerable and low-income individuals in their populations, and this would grow at the rate of inflation.

      Additional policies

        Apply the Hyde Amendment, an important policy to protect innocent human life that has been supported by Republicans and Democrats alike for nearly four decades, to funding and tax credits provided under this proposal.

        Implement conscience protections, so health care providers can practice medicine in ways that do not violate their moral or religious convictions.

        Readopt the “Reagan rule” to prevent Title X taxpayer dollars from going to entities that provide or refer for abortions.

        Enable states to stop Medicaid funding of organizations that provide or refer for abortions by clarifying that states have this discretion over how they operate their Medicaid programs.

      Strengthen and secure Medicare

        Governor Bush will release a separate plan to strengthen and secure Medicare.


        ObamaCare promised to fix a broken health care system; but instead, it doubled down on the status quo and left millions of Americans, particularly middle-income families, worse off.  This proposal takes the opposite approach.  It repeals Washington’s power grab, empowers individuals with choice and security and allows the states to design their own solutions.  Instead of assuming the government can solve every problem, it establishes a fair, vibrant and transparent market for entrepreneurs to design innovative solutions to lower costs and improve access to care.  This proposal will move us from a system stuck in 1965 to one that empowers individuals and embraces the future

        Jeb 2016
        October 13, 2015

        Good Reads on Jeb's Health Plan - “the best in the field”

        Today Jeb rolled out his health care plan that repeals Obamacare and offers a conservative plan of health care for the future and returns power to states, communities and families. 

        It has been called “the best in the field” and “among the most serious and substantive conservative health-reform proposals."

        See below for some initial reactions. 

        National Review, Yuval Levin – Jeb Bush’s Obamacare Replacement 

        … what’s here is among the most serious and substantive conservative health-reform proposals we have seen from a Republican presidential candidate. It speaks to both the problems created or exacerbated by Obamacare and to the serious flaws of the pre-Obamacare health-financing system.

        National Review, The Corner - Ramesh Ponnuru - Jeb Bush’s Solid Health-Care Plan

        Bush has the best plan in the field

        Forbes, John Goodman - The Jeb Bush Health Plan

        In contrast to Obamacare, the Bush health plan envisions a much smaller role for government and a much bigger role for individual choice and competition in the marketplace.

        Under the Bush plan, no employer would be punished for creating jobs.

        Washington Examiner, Phillip Klein - Here’s how Jeb Bush would repeal and replace Obamacare

        The Bush plan would also move to give more flexibility to states. In a departure from the approach taken by Obamacare, which mandated that insurers cover those with pre-existing conditions and expanded Medicaid, under Bush's proposal, the federal government would send a capped amount of money to states to provide coverage to low-income individuals and those with pre-existing conditions based on the states meeting certain outcomes.

        Weekly Standard, Jeffrey Anderson - Bush’s Obamacare Alternative Suggests Consensus Is Forming

        Bush’s alternative would fix what the federal government had already broken even before Obamacare was passed and made everything so much worse.  For 70 years, Americans have gotten a tax break for getting health insurance through their employer, while millions of their fellow citizens who have bought insurance on their own have gotten no tax break whatsoever.  Bush’s plan would end this inequality in the tax code, which is at the root of America’s (pre-Obamacare) health-insurance woes.

        Jindal for President
        October 13, 2015

        Jindal: Jeb Should Make Case For Obamacare-Lite Plan on Dem Debate Stage Tonight

        WATERLOO, IOWA – Governor Jindal blasted Jeb Bush’s plan to repeal and replace Obamacare calling it “Obamacare-lite” and saying Bush would be better suited to make his case for the plan on the Democrat Presidential debate stage tonight. In April 2014, Governor Jindal was the first candidate to propose a detailed plan to repeal and replace all of Obamacare.

        Governor Jindal said, “I applaud Governor Bush for introducing a health care plan.  I released my plan over a year ago, and I continue to be amazed that no other candidates have demonstrated enough policy interest or depth to even attempt to introduce a plan.

        “Unfortunately, both Jeb’s plan and Obamacare are both new federal entitlement programs in which the federal government pays for universal health care for all Americans.  This is not an opinion, it is a fact.

        “Jeb’s plan is rejection of the American ideal of individual independence, and an acceptance of the left’s demand for more government dependence.  Jeb’s plan is Obamacare lite.

        “President Obama succeeded in doing what Hillary had failed to do years before – to create a new federal entitlement program where the government pays for health care for all Americans.  Never mind the fact that our existing entitlement programs are on the verge of bankruptcy.

        “If Jeb’s health care plan were to become the Republican alternative, it will mean that Obama and the left have won the fundamental debate about health care in America.   It will mean that Republicans have decided to surrender and to accept the idea that taxpayers must pay for a new federal entitlement program providing health care for all.

        “There is an empty podium available tonight for Joe Biden in the Democrat debate.  Jeb should take that spot in order to argue for his Obamacare-lite health care proposal.

        “My plan focuses on the real problem with health care in America – the need to reduce costs.

        “Finally, it appears that Jeb’s plan is silent on the little detail of what it will cost, which is a hallmark of all things Washington.”


        Contact: Shannon Dirmann, Press Secretary

        Democratic National Committee
        October 13, 2015

        DNC Response to Bush's Health Care Plan

        In response to Jeb Bush’s health care plan, DNC spokeswoman Christina Freundlich released the following statement:
        “Jeb Bush’s health care plan would go back to the days of skyrocketing costs, lower the quality of patient care, decrease the number of Americans insured, all while increasing the deficit. The boilerplate “repeal” plan is adverse to the goal of expanding access to quality, affordable insurance and undermines the progress made over the past five years. Any sort of repeal plan would put insurance companies back in control, allow them to discriminate against women, deny coverage to those with pre-existing conditions, and would increase out of pocket costs for preventive care and prescription drugs for seniors. We can’t afford to undo the strides we have made when it comes to consumer protections and the more than 17 million Americans who are now insured.
        “Governor Bush’s Medicaid plan in Florida was a total disaster, as Floridians received low-quality care after Bush sought to give insurance companies more control and gut protections for consumers. Simply put, Floridians did not receive adequate treatment, and the same would go for the rest of the country under another Bush administration. Between his Medicaid experiments and plan to repeal Obamacare, Jeb Bush’s health care plan would fail our country and only look out for himself and people like him.”

        Americans United for Change
        October 13, 2015

        Jeb unveils his "Stuff Happens Plan" for weakening America's health security

        Reaction from Americans United for Change: Jeb Bush’s proposal for restricting access to quality, affordable health care for millions of Americans might as well be called the “Stuff Happens Plan” because that’s the answer they’ll have to get used to in a health emergency. Earlier this year Jeb declared he wants to “phase out” Medicare and replace it with private vouchers that won’t begin to cover seniors’ costs. Today Jeb revealed he’s every bit as hostile to Medicaid, claiming “Being on Medicaid isn’t necessarily a better deal than being uninsured”  as he proposed rolling back the program’s expansion. The two-thirds of America’s nursing residents getting the care they need thanks to Medicaid would probably take issue with that. If elected President in spite of his sinking poll numbers, Jeb vows to replace the Affordable Care Act with insurance industry deregulation and a not-so-triumphant return of the “Don’t Dare Get Sick” policies that fall unacceptably short when needed the most. But all anyone needs to know about Jeb’s plan is, like Mitt Romney’s before him, the fine print includes a sneaky “continuous coverage” clause for Americans with pre-existing conditions like cancer or once having been pregnant.  Under Mitt…err, Jeb’s plan, if you have a pre-existing condition and experience a break in insurance coverage (even for a month) for any of many good reasons (like losing your job), you no longer have guaranteed access to insurance.  That one innocuous sounding word – “continuous” – could have huge consequences, jeopardizing the coverage of up to 89 million Americans.  That’s not a serious health plan – that’s a joke that only the big insurance companies find funny.  There’s already a serious plan in place that’s working to protect consumers from insurance company abuse and giving more Americans the health security they deserve - and it’s called the Affordable Care Act. Thanks to the ACA, the national uninsured rate has plummeted by nearly a third to a historic low of 9.2 percent, with 15.8 million gaining coverage since the health law’s marketplaces opened.  But Jeb and the rest of the GOP field don’t view this as progress, rather an encroachment on insurance companies’ freedom to let families go bankrupt over medical bills.
        KEY POINT: One more key footnote to the Bush plan is its protection for people with pre-existing conditions, which is different from the guarantee in the Affordable Care Act. The Bush plan calls for guaranteeing access, but only for people with "continuous" coverage. That means people whose insurance has lapsed -- say, because they lost a job and couldn't afford premiums for a few months -- could be subject to denial because of their current medical problems.


        Jeremy J. Funk

        Communications Director, Americans United for Change

        New Hampshire Democratic Party
        October 13, 2015

        Despite the Numbers, Jeb Bush wants to repeal Health Care for over 90,000 Granite Staters

        CONCORD, NH - Today, Jeb Bush announced his plan to repeal the Affordable Care Act. But thanks to the Affordable Care Act, New Hampshire is healthier and stronger and we’re seeing a decline in the costs of uncompensated care and savings for individuals. More Granite Staters have access to care they need like preventative services and mental health; and many are now covered because they are able to stay on their parents’ plans and because insurance companies can no longer discriminate based on pre-existing conditions.

        “As Jeb Bush announces his plan today to destroy the Affordable Care Act that has helped thousands in the Granite State, he should really take a look at the numbers here in New Hampshire,” said New Hampshire Democratic Party Chair Ray Buckley.

        “Thanks to the Affordable Care Act, over 90,000 Granite Staters now have health insurance, seniors have saved millions on their prescriptions, and thousands have access to free, preventative health care services. Bush’s plan would roll back all the advances we’ve made – he would put insurance companies back in control, would fail to protect seniors from rising prescription drug prices, and would allow women to pay more than men for coverage. Granite States can’t afford to undo the strides we have made when it comes to consumer protections and the tens of thousands now covered across the state. Simply put, Bush’s health care plan would fail our country and only look out for people like himself.”

        By the numbers, here is how the Affordable Care Act is helping Granite Staters.

        Thanks to the Affordable Care Act, More Granite Staters are Covered by Affordable Health Care Coverage and Medicaid Expansion

        Over 53,000: Number of Granite Staters enrolled in private health insurance on New Hampshire’s Health Insurance Marketplace. 

        $244: Average tax credit for 70% of Granite Staters enrolled in the Marketplace. 

        $100 or less: What 43% of Granite Staters on the Marketplace pay for their coverage. 82% had the option of doing so. 

        16,918: Number of Granite Staters under the age of 35 that signed up for coverage under NH’s Marketplace.

        $161: Average refund per New Hampshire family from insurance companies, thanks to rule that companies have to spend 80 cents of your dollar on health care or provide a refund.

        Over 42,000: Number of Granite Staters now covered through New Hampshire’s Medicaid expansion plan.

        Thanks to the ACA, Granite Staters with Chronic and Pre-existing Conditions are Now Protected

        545,000: Number of Granite Staters with chronic conditions that no longer have to worry about a lifetime limit on health benefits. This number includes 140,000 children and 208,000 women. 

        597,050: Number of non-elderly Granite Staters with a pre-existing condition that insurance companies can no longer deny coverage. This includes 68,589 children.

        Thanks to the ACA, Granite Staters have More Access to Mental and Substance Abuse Benefits 

        253,680: Number of Granite Staters affected by the ACA’s expansion of mental health and substance abuse benefits.

        Thanks to the ACA, Granite Staters have More Access to Preventative Care

        382,000: Number of Granite Staters that now have preventative coverage like cancer screenings, check-ups for children, and flu shots.

        152,000: Number of Granite State women that now have expanded preventive services.

        Over $8 million: Amount in grants provided by the ACA for policies that prevent illness and promote health such as efforts to quitting smoking and preventing obesity.

        Thanks to the ACA, New Hampshire Seniors Have Saved Millions on Prescription Drugs and Received Critical Preventative Services

        $52,874,555: Amount Granite Staters with Medicare have saved on prescription drugs thanks to the ACA.

        183,862: Number of Granite Staters with Medicare that received preventative services in 2014.

        Thanks to the ACA, More Young Adults in New Hampshire Are Covered

        10,000: Number of young adults in New Hampshire now have insurance because they can stay on their parents’ health care plans until age 26.

        [Data from HHS]


        Democratic National Committee
        October 15, 2015

        The reviews are in on Jeb Bush’s health care plan: it would be a disaster for the American people

        Jeb Bush released his health care plan earlier this week, and the reviews are in: it would be a disaster for the American people. His plan would repeal Obamacare, which has helped over 17 million Americans gain health insurance, would increase the deficit, lower the quality of patient care, decrease the number of Americans insured, and only help Jeb Bush and the wealthy like him.
        And let’s not forget that Governor Bush’s Medicaid plan in Florida was also a total disaster, as Floridians received low-quality care after Bush sought to give insurance companies more control and gut protections for consumers…
        Read all about what people are saying on Jeb Bush’s health care plan below:
        Rather, Bush's plan would disproportionately affect lower-income people, according to several nonpartisan experts who spoke to NPR.
        Aside from potentially cutting Medicaid benefits, the size of Bush's tax credits are adjusted based on age, not income, according to the New York Times.
        "This is not a wise path if one's priority is to protect Americans facing the greatest economic and health risks," said Harold Pollack, professor at the University of Chicago's School of Social Service Administration, in an email.
        James Flathers, a longtime Republican voter who has Parkinson’s disease, said the president’s health care law was a financial savior when he had to switch jobs.

        [with regard to Jeb Bush’s plan,] “I think it would crush people like me,” he said.
        LA Times:
        But the plan, like many alternatives offered by critics of the Affordable Care Act, does not include key details, including how it would be paid for.
        Bush’s tax credits and other government assistance would likely cost hundreds of billions of dollars, yet Bush has proposed to scrap the taxes and other revenue that generate hundreds of billions of dollars in the current law.

        Capping Medicaid expenditures and tying assistance to a consumer's age, as Bush would do, rather than to income, would almost certainly leave many low- and middle-income Americans with fewer protections.
        Huffington Post:
        Jeb Bush on Tuesday will introduce a plan to repeal and replace the Affordable Care Act.
        But “replace” may not be quite the right word.
        The Bush plan calls for a familiar mix of conservative ideas on health care, according to campaign documents obtained by The Huffington Post. It would eliminate the coverage scheme of “Obamacare” -- the tax credits, regulations on insurance, and individual mandate that have led to a historic reduction in the number of uninsured Americans.

        “Repealing Obamacare and replacing it with fixed tax credits would hurt low-income folks who finally just got decent insurance,” Len Nichols, a former Clinton administration official and widely respected health economist at George Mason University, told The Huffington Post.
        Bush’s designs on Medicaid would likely have a similar effect. While the campaign has not specified how much money the states would get under Bush’s scheme, conservative plans to hand control over to the states generally call for less spending on the program. Medicaid is already under-funded. If states had even less money with which to manage it, they’d almost surely have to restrict eligibility or cover fewer services -- either of which would mean less financial protection, in this case for the very poor.

        One more key footnote to the Bush plan is its protection for people with pre-existing conditions, which is different from the guarantee in the Affordable Care Act. The Bush plan calls for guaranteeing access, but only for people with "continuous" coverage. That means people whose insurance has lapsed -- say, because they lost a job and couldn't afford premiums for a few months -- could be subject to denial because of their current medical problems.
        Buried in his speech at St. Anselm College was an admission that part of his plan is working with the states on “transition plans” for the 17 million or so people who have gained coverage under Obamacare. In other words, after Obamacare gave insurance coverage to the previously uninsured, Bush is promising to yank it away again while waving at a vague promise to help people move into yet another new, unspecified system.
        And what a system it would be. Bush’s plan would rely more on access to “catastrophic care” plans, the junkiness of which were one of the motivating factors for Obamacare’s provisions that all insurance must provide minimum standards of care. He has promised to “return power to the states,” which is usually code for deregulating state markets and turning Medicaid into a block grant program, actions that disproportionately hurt the minorities and poor who rely on the program for healthcare access.