Ben Carson’s rise to Republican presidential front-runner has come without serious scrutiny of his domestic policy proposals.
But his high-flying campaign has hit some turbulence since he began discussing his desire to replace the Affordable Care Act with a health care system that offers all Americans a government-funded health savings account.
Carson thinks the tax-preferred accounts, which are often paired with a high-deductible health plan, would curb enrollment growth in the Medicare and Medicaid programs – but not eliminate either one altogether.
“The program that I have outlined using health savings accounts, starting from the time you are born to the time you die, largely eliminates the need for people to be dependent on government programs like that, but I would never get rid of the programs,” Carson recently told Fox News.
The retired pediatric neurosurgeon’s proposal is way short on details and fuzzy at best. He hasn’t issued a formal plan, summary statement or even talking points to explain it.
So here’s what we think we know about Carson’s plan to overhaul the nation’s health system:
– He wants to give each American, depending on income, some $2,000 to $5,000 a year for the entirety of their lives to fund their health savings accounts, or HSAs. The money would cover basic health expenses, and family members could pass their account to other family members upon their death.
For 80 million low-income people, Carson would fund their accounts with $5,000 a year, using $400 billion that Medicaid now spends to provide their care.
– Carson would allow seniors to stay with Medicare or have their program funding steered into a personal HSA.
– For working Americans who get employer-based health coverage, Carson appears ready to jettison the nation’s largest tax subsidy for private health coverage: the tax benefits that encourage employers to pay for the bulk of their workers’ health coverage.
Excluding those payments from income and payroll taxes would cost the federal government $334 billion this year, according to a recent article by Larry Levitt, a senior vice president at the Kaiser Family Foundation.
“Instead of that money going into the inefficient system that it goes in now,” Carson says he would have it “divided and divvied up into your family’s health savings account, over which you now have control and to which you can contribute anything you want.”
As more people use their HSAs to cover basic health needs, Carson says they could also buy additional catastrophic coverage for major health issues. Catastrophic plans typically have low premiums but high deductibles.
“It’s sort of like having a homeowner’s policy with a big deductible versus a homeowner’s policy where you want every scratch covered. Two completely different animals,” Carson explained on “Meet the Press.”
By moving away from government programs to uniform subsidies that cap federal spending and give individuals more control of their health dollars, Carson’s rudimentary plan continues a common thread among GOP proposals to overhaul health care, Levitt said.
“But Mr. Carson’s apparent plan takes it a lot further than anyone has before, that I can remember,” Levitt said. “. . . It could work out great for folks who are healthy and let money build up in their accounts, but it could really stick it to people who are really sick and have health expenses.”
If consumers do have trouble with costs, Carson’s solution would keep it all in the family.
It’s sort of like having a homeowner’s policy with a big deductible versus a homeowner’s policy where you want every scratch covered.
Presidential candidate Ben Carson
“We give people the ability to shift money within their health savings account within their family,” he said on “Meet the Press” last week. “If you’re $500 short, your wife can give it to you out of her’s or your daughter, or your uncle, or your cousin . . . it gives you enormous flexibility without a middleman.”
While there’s evidence that health savings accounts can save money, research shows people with HSAs forgo care because of the high deductibles and co-pays, said Deborah Freund, a health care economist at the RAND Corp., a California-based think tank.
“Right now, people who are covered by Medicaid, even under Obamacare, forgo care because they cannot pay their deductible, and HSAs always have a higher deductible than that,” she said.
For Carson’s rudimentary plan to work, Freund said consumers will need a lot of information about which treatments are needed and cost-effective and which doctors give high-quality care.
“And right now in this country, we don’t know how to give that information in a way that people can understand and process,” Freund said. “Even I would have a hard time getting the information I would need to decide whether to spend that next $100 getting a procedure my doctor recommended for me. And if so, from who? It’s very difficult.”
Carson’s plan already has changed substantially. At first, he wanted the government to fund health savings accounts for all Americans with $2,000 a year for life.
As media scrutiny of his plan continues, expect more details, and especially more changes.
“I’m not a politician,” Carson told Fox News. “So I don’t say that because I thought this a while ago before I had an opportunity to talk to a lot of economists and various people and cost it out, that I can’t change my mind.”