Health Care

Talking Points

  • Obamacare is unpopular, unworkable, and unaffordable, and should be stopped and repealed in its entirety. Then Congress and the states should pursue patient-centered, free-market reforms that get health care reform back on track.
  • Obamacare undermines the doctor–patient relationship, limits patient choice, centralizes control, and increases costs totaxpayers.
  • Obamacare creates two new entitlements that will cost taxpayers almost $1.8 trillion over the next decade.
  • Congress should repeal the Obamacare statute and enact patient-centered, market-basedreforms.

The Issue

Individuals and families should have greater control of health care dollars and decisions through a patient-centered, competition-driven system. The Patient Protection and Affordable Care Act (Obamacare) turns the health care system into a centralized, top-down federal government system. Obamacare interferes with the relationship between millions of patients and their doctors and increases dependence on the government for the delivery of care and services.

Moreover, striking at the heart of American federalism, Obamacare reduces states to mere vehicles for implementing federal policy through its health care exchanges. For the first time, Americans are required to buy federally approved health insurance regardless of their personal wants or needs, with few exemptions and under penalty of federal monetary fines.

To achieve a patient-centered, competition-driven health care system, lawmakers must first repeal Obamacare, as Congress cannot create a market of consumer choice and competition on the foundation of federal bureaucracy and central planning. Then Congress must provide solutions that let people have personal ownership and real portability of their health care, expand people’s access to health care by embracing free-market innovation, and help states to address the challenges faced by the vulnerable in ways that limit unintended consequences.


  1. Repeal Obamacare. Congress must repeal Obamacare in its entirety. The law is unaffordable, unworkable, and unpopular. The costs associated with Obamacare continue to grow. In 2010, the Congressional Budget Office (CBO) estimated that the new health care subsidies and Medicaid expansion would cost $898 billion between 2010 and 2020. Now, three years into the law, the CBO projects almost $1.8 trillion in new health care spending over the next decade. This change challenges early claims that the law would bend the cost curve down and reduce the deficit. Instead, it further confirms that these claims were based on Washington budget gimmicks and phantom savings.

    Obamacare’s federal regulatory regime intrudes into almost every facet of private insurance and care delivery. It usurps the roles of the states and gives the Secretary of Health and Human Services sweeping new power to impose a wide range of new rules and regulations that undermine choice, increase premiums, and destabilize the marketplace. Obamacare implementation has already generated over 10,000 pages of regulations. Millions of Americans find their existing health insurance policies cancelled due to Obamacare.

  2. Enable Americans to choose, control, and keep their health insurance. The largest obstacle to individuals owning their own health insurance is the tax treatment of health insurance. Today, the tax code provides generous tax relief to individuals who obtain their health insurance from the place of work, but it provides no similar relief for individuals who purchase their own coverage.

    Congress should reform the tax treatment of health insurance to provide tax relief for individuals who purchase coverage on their own. Congress should pay special attention to equalizing the tax treatment between employer-based coverage and individual coverage.

    The vast majority of Americans are enrolled in group insurance and are legally protected from exclusions from insurance coverage because of pre-existing conditions. However, individuals in the relatively small population that lacked group insurance coverage and had pre-existing conditions sometimes faced prohibitively expensive premiums to obtain insurance coverage or could not obtain it. To address those who are uninsured with pre-existing conditions, states should consider establishing their own high-risk pools and pursuing additional and innovative risk-adjustment mechanisms that keep costs under control.

  3. Encourage employers to provide portable health insurance benefits. Today’s workforce is far more mobile than the workforce of a generation ago. No longer does a worker take a job with one employer and stay with that same employer throughout a career. These changes can also have a direct impact on a worker’s health insurance. Each time a worker changes jobs most likely entails another change in his or her health care coverage. For some, a change in job may even result in losing coverage altogether if the new employer does not offer coverage.

    Moving employer-based health care from a defined-benefit model to a defined-contribution model would allow individuals to maintain ownership of insurance regardless of job or job status and would enable employers to provide financial assistance in a more predictable way. To facilitate more portable insurance at the place of work, Congress should remove any limitations that prevent or discourage employers from shifting from a defined-benefit model to a defined-contribution model in health care.

  4. Let the free markets provide the insurance and health care services that people want. Most health insurance is governed by state law and to some extent by federal law. Such rules define and limit the kind of health insurance and health care that is available to individuals, families, and businesses. Many times, these restrictions stifle innovation and prevent individuals from getting the kind of health care that best meets their needs at a price they can afford. Moreover, the third-party payment system (dominated by the government and employers) aligns insurance plans with the payer rather than the consumer.

    To expand access to affordable health care, there are many policy ideas that Congress should pursue. For example, Congress should revise existing rules on consumer-directed health care products that offer consumers an opportunity to save for their health care; remove barriers to interstate commerce in health insurance, thereby increasing competition and expanding the health insurance options for individuals; remove barriers that prevent new, more individual-based pooling arrangements from emerging outside the place of work; and move the Medicare program to a premium-support model to increase choice and competition for seniors in private health insurance markets.

    States can also take the lead in improving access by ensuring that their rules and regulations do not add to the cost of insurance, reforming their medical liability laws, and removing barriers that restrict the supply of providers and health care facilities through reform of medical licensure and certificate of need laws. Finally, both state and federal policymakers should weed out fraud, waste, and abuse in government programs.

  5. Assist those who need help through civil society, the free market, and the states. The poor face obstacles to entering the health insurance marketplace. The federal- and state-funded health program, known as Medicaid, has an inferior record in delivering quality health care and outcomes and has grown beyond its role of helping with the health needs of the poor. To address the needs of the poor, states, with additional flexibility from the federal government, should start to reform their Medicaid programs to give all Medicaid beneficiaries access to superior private health insurance options. In addition, all levels of government should remove barriers that inhibit institutions of civil society from caring for those in need even more than they already do.
  6. Protect the right of conscience and unborn children. The government should not compel individuals to undertake or pay for actions that violate their deeply held ethical, moral, or religious beliefs. Religious freedom, in particular, is the “first freedom” of all Americans, protected by the First Amendment of the Constitution and reaffirmed in subsequent laws and statutes.

    Congress should protect the right of consumers, insurers, employers, and medical personnel not to be compelled to provide or finance health care services that are contrary to their conscience or the tenets of their religious faith. Congress should also make permanent in law the existing prohibition on the use of federal taxpayer dollars to finance abortions or health coverage that includes elective abortions. At the federal and state levels, policymakers should work to remove any barriers that prevent health plans sponsored by religious and other faith-based organizations from participating in the market and in government programs such as Medicare, Medicaid, and the Federal Employees Health Benefits Program (FEHBP).

Facts & Figures

  • In 2011, the United States spent $2.7 trillion, or 17.9 percent of GDP, on health care.
  • By 2022, it is expected that government (federal, state, and local) will finance nearly 50 percent of all health care spending.
  • 42 states will see premium increases in the exchanges, and premiums will more than double in some states.
  • The existing tax exclusion for employer-sponsored insurance amounted to $248 billion in 2013.
  • HSA-eligible policies have grown from 1 million in 2005 to 15.5 million in 2013.
  • States imposed 2,271 benefits nationwide in 2012.
  • Medicare has $36 trillion in long-term unfunded obligations, and enrollment is expected to reach 81 million by 2030.

Selected Additional Resources

Heritage Experts on Health Care

  • Edmund Haislmaier

    Senior Research Fellow, Health Policy Studies

  • Robert Moffit, Ph.D.

    Senior Fellow

  • Nina Owcharenko

    Director, Center for Health Policy Studies and Preston A. Wells, Jr. Fellow

To talk to one of our experts, please contact us by phone at 202-608-1515 or by email.