(CNN) — Jeb Bush unveiled his plan Tuesday to repeal and replace Obamacare with a system that he believes will cut back on regulation and lower health care costs.
The Republican presidential candidate echoed a recurring theme from Republicans in the 2016 presidential race, knocking the President and his signature health insurance law for what he described as an egregious example of government overreach that’s wreaked havoc on the economy.
“It’s quite a legacy, if you think about it, and when you consider the wreckage, it makes you wonder how could anybody support this now,” the former Florida governor said at the New Hampshire Institute of Politics at Saint Anselm College.
“Well, Hillary Clinton supports it and so does Bernie Sanders and other Democrats,” he continued. “And the debate tonight in Las Vegas will probably prove they will be strongly supportive of this top-down driven, highly bureaucratic insurance plan that stifling our ability to rise up.”
Instead, Bush said he envisions a system that allows the state exchanges to continue to exist, if they so choose, but would not be mandatory. He wants to enable access to affordable, catastrophic plans and provide a tax credit to purchase policies that protect Americans for costly medical events.
Bush also wants to expand Health Savings Accounts, one of his elder brother’s pet programs. He would increase contribution limits and uses for these accounts, which must be paired with high-deductible health plans. Enrollees can use the funds in their accounts to pay for medical care.
His plan focuses on ending mandates and encouraging incentives, instead. “We won’t force people to buy coverage they don’t want either because they don’t need it or it violates their conscious,” he said.
Bush doesn’t favor doing away with everything from the current law. He supports the continuous coverage guarantee provision for people with pre-existing conditions, and previously Bush has said he favors allowing kids to stay on their parents’ insurance plans until the age of 26.
But he would also employ some well-worn conservative ideas, including transferring responsibility to the states to run their own insurance markets and administer their health care safety net. Bush favors capping federal funding to the states — a policy Democrats and consumer advocates say would leave the vulnerable stranded during tough economic times, when applications for Medicaid traditionally soar. Bush would also require able-bodied Americans to work while receiving Medicaid.
To promote innovation, he also wants to reform the Food and Drug Administration’s regulatory policies and increase funding and accountability at the National Institutes of Health, according to the campaign.
Bush also wants to see more hospitals list their costs for procedures online, and he envisions “an app on your smart phone that calls your doctor to your front door, just as it does for a car to come pick you up.”
Repealing Obamacare will not be a simple task. There are more than 10 million people enrolled in the federal and state Obamacare exchanges. Some 87% of them are receiving federal subsidies — averaging $272 a month — to lower the cost of their premiums. And 56% of them receive separate subsidies to reduce their out-of-pocket expenses.
Also, Bush would jettison the expansion of Medicaid to all Americans under age 65, which 31 states and Washington have adopted. Nearly 13 million people have joined Medicaid since October 2013, when expanded enrollment began. Prior to Obamacare, it was difficult for adults, particularly childless adults, to sign up for the safety net program in many states.
But in an interview this weekend, Bush described Medicaid and its expansion as “one of the worse insurance programs in the country.”
He pointed Tuesday to his record as governor when his administration created a pilot program for lower-income beneficiaries that focused on more tailored insurance plans and lowered health care costs. Florida Democrats, however, argue that the program wasn’t successful, citing an increase in uninsured people during the course of his eight-year tenure.
Bush’s plan also shifts away from Obamacare’s focus on preventative care. Under health reform, insurers must provide so-called essential health benefits, including mental health counseling, maternity coverage and emergency services. Also, enrollees in Obamacare plans can get an array of free annual screenings — for conditions such as diabetes and high blood pressure — and vaccines. Women can get an annual gynecological visit and mammograms.
Bush’s campaign says he would allow employers to use financial incentives to encourage wellness programs.
Following his speech, Bush did not take questions from the audience but was asked about details in his plan by state Rep. Claire Rouillard, a Republican from Goffstown, and Donna Sytek, a former speaker of the New Hampshire House, while Bush was shaking hands with voters.
Rouillard said she liked Bush’s proposal involving more price listings of hospital procedures online, but wanted to know more specifics about whether he would require means testing and how he would ensure coverage for more people.
Sytek pressed him on how coverage for substance abuse recovery would be folded into his plan, but he argued that such action would fall under SAMHSA, the Substance Abuse and Mental Health Services Administration, rather than under a federal health care law. Sytek said she needed to do more research on the issue but stressed that such services will be a huge factor in any kind of health policy.
Bush’s speech Tuesday comes amid a series of major policy addresses he’s given on other issues involving foreign policy, energy and government reform.
Sytek argued that while he has ideas, his candidacy has yet to see the enthusiasm that other candidates are surging on.
“He’s got substance, but he doesn’t have sizzle,” she told reporters. “And right now sizzle is the name of the game.”
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