HealthcareIssuesHealthcare After Obamacare Highlighted by Rep. Roy, Others at TPPF Panel

The healthcare panel at the Texas Public Policy Foundation's annual summit highlighted key policies participants believe will drive down costs and improve quality of care were Obamacare to be repealed.
January 22, 2020
A day after the Supreme Court denied a request to expedite an appeal of the Fifth Circuit Court’s decision that Obamacare’s individual mandate is unconstitutional, a panel at the Texas Public Policy Foundation’s (TPPF) 2020 policy orientation occurred, titled “A Final Act for the ACA: What Comes Next After Obamacare is Struck Down?”

Rep. Chip Roy (R-TX-21) headlined the panel with Cynthia Fisher, founder of, and Rob Henneke, general counsel for TPPF. David Balat, the head of the foundation’s healthcare research, moderated the event.

After a recap of the case from Henneke, who is representing a pair of plaintiffs in the lawsuit, Roy stated, “We should also credit the Trump administration for not defending Obamacare.”

A coalition of blue states, led by California Attorney General Xavier Becerra, is arguing in favor of Obamacare’s preservation. The main opposing coalition is led by Texas’ Attorney General, Ken Paxton.

“[President Trump] was getting a lot of pressure to defend it by many in his administration,” Roy added.

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Overall, the focus was on increasing transparency in pricing, competition in the market, and improving the doctor-patient relationship.

About the progress that has been made, Roy stressed, “Republicans have things they can positively talk about – direct primary care, going to doctors of your choice, being able to shop for care outside of the insurance model, preventing insurance and government bureaucrats from getting between you and your doctor, being able to control your healthcare dollars and making them portable from job to job.”

In July, Roy introduced legislation to mint “Health Freedom Accounts” — essentially health savings accounts but with more flexibility in contribution size and portability of coverage.

“We’ve got to break the back of this current system where patients are stuck in the stovepipes where they’re stuck in the supply chain [caused by] an insurance company in another state telling you what your healthcare is,” Roy added further.

Fisher, expounding on the rising expenditures Americans are facing, stated, “[Consumers] are facing out of network billing that not only affects their wallets but also their choices, like choosing between putting food on their table or education for their children.”

Talk about healthcare costs is a drum both conservatives and progressives routinely beat, but while those on the left look to increased government subsidization (some even going so far as full government-controlled “single-payer” proposals), the right’s healthcare advocates want to move the government away from the system.

“Individuals and families are approaching a breaking point with 20 percent of our economy going to healthcare,” Fisher added.

She continued, “47 percent of our country’s insured have high-deductible plans…$20,000 is now the average cost, per employee, for a family of four.”

Costs in the typical, insurance-hospital-based healthcare exchange are rising rapidly, and little relief is expected.

“On top of all that, we’re expected to pay for our healthcare with a blank check and have no seat at the negotiating table,” Fisher lamented.

The group touted a different model as an option forward: direct patient care.

“Cash rates are 40 percent less than the negotiated rates,” Fisher stated regarded the business model that operates outside of the insurance-based one.

Increasingly, doctors have opted to operate outside of that system for services ranging everywhere from primary care, ophthalmology, surgical centers, and beyond. These businesses tout their competitive advantage with pricing and quality of care.

For example, on pricing, a hip replacement at Texas Free Market Surgery costs about half of what it does on average at a hospital.

One topic most Republicans have found difficult to tackle is the pre-existing condition question. The population who are ineligible for Medicare, Medicaid, and are unemployed that have a pre-existing condition is a little less than eight percent. For this population, it can be difficult to find affordable coverage because of their already-existing health issues.

Roy expounded on the issue, saying, “The greatest obstacle is the defensive posture everyone finds themselves in with respect to coverage when it comes to pre-existing conditions.”

With that subject “driving the entirety of the debate” surrounding healthcare, Roy finds it troublesome to base the whole discussion on such a small portion of the population.

He added, “We don’t talk about how quality of care and getting the prices down is the path forward for healthcare being accessible to the vast majority of all Americans.”

Back to spending, Balat lamented, “We spend $80 billion a year on the Obamacare exchanges.”

A real-world example he pointed to was Rudy’s BBQ which cut its healthcare costs by 50 percent when it switched from an insurance-based plan for its employees to a direct, cash-based one.

Each panelist stressed the importance of allowing consumers to find “the highest quality care at the lowest possible price,” which in their minds requires removing the government from the equation.

The Texan asked two of the panelists afterward about their thoughts on a potential legal challenge to the Trump administration’s executive order requiring hospitals to list their actual prices rather than estimates — a move each panelist praised.

Neither Fisher nor Henneke was concerned about the constitutional standing of the executive order.

Fisher, whose organization will file an amicus brief in the eventual court case on this issue, is confident it will hold water.

She stated, “We already get to know prices, just not until after we purchase care. So, all we’re saying is move that practice to the front of the process.”

Pointing to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Fisher said consumers have right of access to pricing. This law, Fisher says, is one of many support beams for the constitutionality of the executive order.

Henneke added, “There are longstanding powers of regulating healthcare by the federal government, and this move is consistent with how [the federal government] has to date operated on healthcare.”


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Brad Johnson

Brad Johnson is a senior reporter for The Texan and an Ohio native who graduated from the University of Cincinnati in 2017. He is an avid sports fan who most enjoys watching his favorite teams continue their title drought throughout his cognizant lifetime. In his free time, you may find Brad quoting Monty Python productions and trying to calculate the airspeed velocity of an unladen swallow.