5 views by Congressman Marshall on health care reform

July 01--U.S. Rep. Roger Marshall, R-Great Bend, said he purposely remained silent when the health care legislation spotlight shifted to the Senate.

"I didn't want to over-react to every up and down," he said.

"When we look at the current health care debate, we have to ask if we are making improvements to the current system in several areas: Are we putting the doctor and patient back in charge of care? Are we decreasing premiums? Are we treating states who expanded Medicaid and those who didn't fairly? Are we allowing for competition to drive value?" Marshall asked.

A physician and freshman Congressman, Marshall anticipates a replacement for the Affordable Care Act will emerge from Capitol Hill before the Congressional August recess and go to the White House for President Donald Trump's signature.

In a phone interview Friday, Marshall expressed his views on:

* Medicaid distribution: "Right now it's not equitable," he said of Medicaid dollars going to states. States that expanded Medicaid under the Affordable Care Act are treating it as economic development, he said. It just doesn't seem reasonable, he said, that some states see the federal Medicaid matching rate of about 57 percent while others see virtually 100 percent. He would bring up non-expansion states such as Kansas, but lower amounts to other states.

* Medicaid spending: It's grown to $600 billion annually and is on an upward trajectory, he said, expressing concern. Both the House and Senate plans would spend more on Medicaid but would lower the rate of growth, he said.

* Incentives to buy and keep health insurance: All three strategies -- the House and Senate bills and the Affordable Care Act -- have incentives, penalties or mandates to encourage the uninsured to get coverage. One of the problems with Obamacare, Marshall said, was that it is too easy for someone who is uninsured but needs insurance for medical procedure to jump in and get coverage and then jump out. There needs to be some incentive that works, he said, and mentioned a surcharge that would be imposed after someone allowed coverage to lapse.

* Transparency: "I have yet to see a good bill on transparency," he said. He would like to see pharmacies list drug prices on their websites. Hospital charges, too, should be more transparent, so people can compare the cost of hip replacement surgery, for example, at different hospitals. "I think they want to know what the costs are and the outcomes," he said.

* Congressional Budget Office: It estimated the number of uninsured would grow by over 20 million people under either the House or Senate plan. Marshall didn't put much stock in the estimates. "They missed the mark already," he said, by overestimating the number of new enrollees under the Affordable Care Act.

Marshall said he has been encouraged by discussions taking place behind the scenes.

"I think we're much closer than ever before," he said, to a new health care plan for the country.

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