First Thoughts: The Briefest Analysis of Rand Paul’s Obamacare Replacement Act

These are my thoughts while reading Rand Paul’s Obamacare Replacement Act for the first time. I’ll probably think about it more later, but this is my “live” first take.


Repeal “essential health benefits requirement” – Basically, say insurance doesn’t have to cover anything again. Ugh. Not a good idea, and probably the idea that will kill it in the first paragraph.

“and other insurance mandates” – People will probably have to pay for vaccines and preventive care out of pocket, instead of having them covered 100%

“Provides a two-year open-enrollment period under which individuals with pre-existing conditions can obtain coverage.” – Not sure if this is #1: 2 years from now or #2: 2 years from whenever you lose coverage, even if that is 3 years from now…If its #1, BAD. #2, Eh, not super cool, but pretty good.

“Equalize the Tax Treatment of Health Insurance” – Cool, like it.

“Purchase of Health Insurance from HSA Account” – Here ya go, rich people. Another way to hide your money and get more tax deductions! Unlimited contributions (in previous section) to a tax-free account that you can use for pretty much anything for anyone in your family? Sign me up! To be fair, the benefit for this would really begin with the middle class, but it would kind of help them and seriously help the wealthy

“Medical Expenses Incurred Prior to Account Establishment” Pay for previous medical bills now since you can afford them because we made your payments tax-free. Eh, whatever. I like when our bills get paid.

“Administrative Error Correction Before Due Date of Return” I’ll agree to almost anything if this gets passed. Yes, yes, yes. We have 90 days to get a valid claim to insurers, and they have 15 years to take it back if they find a mistake. Frustrates me all the time.

“Allowing HSA Rollover to Child or Parent of Account Holder” – See previous rich person benefit. Tax-free account, unlimited contributions, rollover to almost any relative…add that up and you have the perfect money funnel.

“Nutritional and Dietary Supplements to be Treated as Medical Care” – Rewarding bogus medicine. No to this one, with prejudice.

“Certain Providers Fees to be Treated as Medical Care / Capitated Primary Care Payments” – Rich people benefit. No, because I hate doctors for doing this.

“Provisions Relating to Medicare” – Rich people benefit. Most people need Medicare and don’t have their own money to contribute.

“Charity Care and Bad Debt Deduction for Physicians” – 10% bonus to us because we give away free care? Um, yes, please…but it is a stupid, stupid idea. I want the money, but its stupid, overall.

“Pool Reform for the Individual Market” – Great, insurers do it, so should patients.

“Interstate Market for Health Insurance” – Big fan of this, in theory, but I think the federal government should establish strict requirements that all states must meet to sell across state lines. Basically, they can do it if the policies they offer to other states meet ACA standards.

“Association Health Plans” – Odd to treat patients as labor unions, but it works. We have several patients with these types of plans and they seem to like them. More work for us and them, but it usually results in well-reimbursed claims.

“Anti-Trust Reform for Healthcare” – Insurers don’t negotiate with places as small as us, so I really don’t know about this one. I’d imagine it’d reduce costs for providers.

“Increasing State Flexibility to Conduct Medicaid Waivers” – If this makes Medicaid more efficient or allows people to sign up easier, it’s a good thing.

“Self-Insurance Protections” – Making sure congress can’t change an actual definition. Unfortunately, necessary. Good.