Vital Signs Blog

Blog: Cruz delinks rhetoric and healthcare reality in debate comments

Republican Sen. Ted Cruz Republican Ted Cruz wants to "de-link" health insurance from employment. Photo by Gage Skidmore
There's a big disconnect between Republican presidential candidate Ted Cruz's promise to make health insurance more portable and affordable and what he's actually proposed so far.

The Texas senator said during the GOP presidential debate Thursday in Des Moines, Iowa, that he wants to “delink health insurance from employment, so if you lose your job, your health insurance goes with you, and it is personal, portable and affordable.” But if the Texas senator's “Health Care Choice Act of 2015” became law, most Americans would have fewer options of affordable coverage outside of employment.

During the debate, Cruz, who's neck and neck with Donald Trump in the Iowa polls preceding Monday's Iowa presidential caucuses, vowed to “repeal every word of Obamacare.” He then cited three pet conservative reforms he favors–allowing insurers to sell plans across state lines, expanding health savings accounts, and severing the link between coverage and employment.

“I think that's a much more attractive vision for healthcare than the Washington-driven, top-down Obamacare that is causing so many millions to hurt,” he said.

But he made no mention of key affordability and portability provisions that conservative policy experts support and that have been included in previous healthcare reform proposals by Republican members of Congress. Those include offering tax deductions or credits for households without access to employer coverage and barring insurers from canceling coverage for people who have maintained continuous insurance.

By repealing the Affordable Care Act, Cruz would eliminate the law's blanket ban on insurers' denying coverage based on applicants' health status, making it harder and more costly for people with pre-existing conditions to buy insurance in the individual market. He also would abolish the federal insurance exchanges and premium subsidies that enable Americans to get affordable coverage on their own, outside of employment.

Unlike the recent proposal by conservative policy experts published in Health Affairs, Cruz made no mention of capping the tax exclusion for employer health plans. Some conservatives have suggested eliminating or limiting that expensive tax provision as a way to finance tax deductions or credits to make individual coverage more affordable.

Cruz's 2015 bill focuses primarily on establishing a system to allow insurers to sell plans across state lines, even though some states already allow such sales and few, if any, insurers have taken them up on this opportunity. Many regulators and insurance experts warn that this deregulatory approach would lead to lower-quality plans and consumer abuses.

His bill does include one consumer protection. It would prohibit insurers from reclassifying enrollees or hiking their premiums based on health status or claims experience. But it would allow insurers to terminate lines of coverage and raise rates for all policyholders within a class. In the pre-ACA era, those practices were used by individual-market insurers to discriminate against older and sicker customers.

On Thursday, Cruz dodged Fox News host Bret Baier's question about how he would cover the uninsured after repealing Obamacare. Like Republican presidential rival Jeb Bush, Cruz advocated cheaper, high-deductible, catastrophic insurance plans, despite growing concerns about whether consumers can afford the high out-of-pocket costs in using such plans to obtain care.

Even as Cruz offered up his sketchy healthcare ideas, House Speaker Paul Ryan (R-Wis.) and other House GOP leaders say they are working on a plan to replace the ACA if their party wins the White House in November. Joe Antos, a health policy expert at the conservative American Enterprise Institute who was the lead author of the Health Affairs article, said he and his colleagues are ready and willing to work with any candidates, including Democrats, who want to craft a serious, comprehensive healthcare reform proposal based on free-market principles.

But he's not holding his breath. “At this stage of the game, candidates are more interested in standard one-liners against the ACA as opposed to developing real proposals,” Antos said.


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