He serves as director of the Texas Public Policy Foundation’s Right on Healthcare program.
Balat provided insights on health care and offered solutions to its problems May 20 during a discussion with U.S. Rep. Cathy McMorris Rodgers (R-Wash.) and Texas Public Policy Foundation general counsel Robert Henneke. The panel took questions from the audience. It was broadcast on the TPPF website, YouTube and other platforms and can still be viewed.
The Texas Public Policy Foundation served as lead counsel for the individual plaintiffs in California v. Texas, the case challenging the constitutionality of the Affordable Care Act heard before the U.S. Supreme Court in November.
A decision on the constitutionality of the ACA, popularly called “Obamacare,” is expected in spring or summer. Henneke said the central argument is that the individual mandate, the command on people to have to buy health insurance under the Affordable Care Act, is unconstitutional.
He said the Supreme Court could uphold the earlier verdict and strike down the ACA because the individual mandate is unconstitutional. It also could remove that provision but allow Obamacare to otherwise continue. The other possible ruling could be that because the penalty associated with the individual mandate has been removed, there is “no harm, no foul,” and the ACA would stand as it is.
But he said no matter what the high court determines, the American health care system needs to be treated and cured. Balat said people, including members of Congress and government officials, confuse health care with health insurance.
“Most of the time, when you hear a politician in D.C. talk about health care, they’re not talking about health care the way that everybody else understands,” he said. “We’re talking about health insurance. The ACA is not health care. It’s health insurance. The subsidies are benefiting the insurance companies, not people.”
Rodgers said people are denied access to care because health care providers are aware of huge disparities in compensation for their services.
“And that’s where the government … the promises sound good. But they’re false promises, because they never have enough money,” she said. “Then they are cutting reimbursements to the providers. They are creating waiting lists for actually getting care or gets harder to get an appointment. And there’s a limitation put on even what you have access to. They’re denying care.”
She added, “That’s where we need to continue to promote policy solutions that are actually going to bring down the cost of health care, that are going to empower the patient and the doctor, like price transparency to make those best decisions for themselves.”
Balat said a free market-based health care system is preferable to the current setup. It’s certainly worth considering, he said.
“We haven’t had one for over 60 years,” Balat said. “Government has emboldened many of the organizations that are concealing their prices. Transparency is an issue. We need to have patients be in charge of patient empowerment, giving them a sense and a peace of mind that comes from them being in a relationship with their physician. Having run hospitals, it’s important for everybody to know that health care is local, the community and the family level. How on earth are we going to have those decisions made in D.C. for the folks in McAllen, Texas, or in El Paso, Texas, or Houston? That needs to be done at the local level.”
Balat said there are solutions that deserve consideration.
“What needs to be done most of all is our policies that are pushed through that allow for more transparency that will give us the opportunity to mitigate the existence of these needless middlemen,” he said. “We talk about the high cost of medications. Most of those dollars are stuck in the middle in the supply chain, whether it be group purchasing organizations or pharmacy benefit managers or name the three-letter acronym, and it’ll be there and they’re extracting value and not providing very much in return.”
Rodgers, in her sixth term in Congress, said she is concerned about President Joe Biden and Congress, under the control of Democrats, are pushing for government-run health care system. That’s a socialist approach, she said, and not how Americans want it handled. Instead, she wants an open market to be the driving force.
“I believe we need to continue to focus on the importance of price transparency in our health care system,” Rodgers said. “This is what would empower patients so that they would have more control over their healthcare dollars and their decisions. And it would also foster competition. And that’s how we helped drive down the healthcare costs.”
Rodgers said although Biden has not focused on it, the Trump administration worked hard on price transparency, a point Balat agreed with.
“A lot of good work was done by the prior administration,” he said. “Unfortunately, the Center for Medicare and and Medicaid Services [CMS] in the last couple of weeks has come out and said they’re going to provide an exemption for hospitals and not having to provide the pricing related to Medicare Advantage plans. “With those insurance companies, they don’t have to disclose those prices, which is a gift to the hospitals and does harm the good work that is being done in providing price transparency.”
He said people deserve to know their options and what costs are associated with their care.
“If I have that information available to me as a patient, where am I going to go? I think that’s a pretty easy decision to make,” he said. “But patients don’t have that information today, and that’s something we need to improve upon and empower them with.”
Balat said the manipulation of the private market by the government is an open secret.
“This price caps and setting rates is just doubling down on a failed effort,” he said. “As I mentioned before, that the middlemen in the supply chain, [and] they benefit from a ‘safe harbor’ from the anti-kickbacks statute. And many of you are going to want to rewind what I just said and wrap your brain around that, because why would anybody be given a safe harbor from an anti-kickback statute? Yet they benefit from it quite a bit.”
Balat urged people to read the Healthcare Shopping List on the TPPF website.
“We have a list of laboratories, pharmacy, surgery centers, doctors that all post their cash prices at a very affordable rates that you can pick and choose from,” he said. “There are also the Christian sharing ministries that offer good, affordable coverage.”
Balat said people need to form a relationship with a direct primary care doctor. He also recommended being informed, dig for answers and offer to pay cash for services because often there is a steep discount.
One way to provide better care for all Americans is by ensuring there are enough doctors. That is a growing concern.
Rodgers said Rep. Dan Crenshaw from Texas, like her a Republican member of the House Energy and Commerce Committee, is “leading the charge on that.”
“We do need to recruit more doctors. We need to get more residencies in place in America. We do have a doctor shortage coming up,” she said. “But one of the positives that we learned about COVID-19 was that telehealth is part of a solution. And that’s an area where I believe that we need to continue to promote more access to individuals to be able to get their health care or their provider.”
Balat said there are many reasons to be optimistic about the future of health care in America.
“I wouldn’t be here if I wasn’t hopeful, if I wasn’t optimistic,” he said. “There’s a better way and it’s just a matter of educating and having people be informed.”
Rodgers sees a brighter future, adding, “My optimism for the future when it comes to health care is that we are really on the verge of some incredible breakthroughs.”
