Nashville Business Journal: How Lamar Alexander would fix Obamacare

Posted on November 19, 2014

When Republicans officially take control of the Senate at the start of 2015, U.S. Sen. Lamar Alexander (R-Tenn.) will land the role of chairman on the Senate Committee on Health, Education, Labor & Pensions.

Since Alexander hails from a state where health care is, in many ways, king, I chatted with the senator Wednesday morning to get a sense of what he'd like to see happen to the Affordable Care Act under a Republican-controlled Congress.

"Obviously we would prefer to repeal and replace this. And there will probably be a vote and I will vote for it," Alexander said. He added, though, that it's very unlikely Barack Obama would sign a law repealing the signature health reform bill that colloquially bears his name.

Even if a repeal effort fails, "the responsible thing is for Republicans to look past it," Alexander continued, and find ways to "repair the damage done."

"Fundamentally," he said, "we want to give Americans more choices and lower costs for their health insurance."

Alexander provided examples of piecemeal steps the Republican Congress could take that would, in his view, improve Obamacare's provisions.

Those include strengthening health savings accounts, allowing small businesses to band together to offer coverage, improving access to plans across state lines and allowing for major medical health plan options — all provisions that have been proposed by Senate Republicans. Alexander himself is the lead Senate sponsor of a bill that would free employers to incentivize healthy lifestyle choices like quitting smoking or losing weight.

Alexander said he also supports multiple bills that call for the repeal of the medical device tax, which he said "adds to the cost of health care and is driving companies out of Tennessee," especially Memphis, where medical device companies are common.

But here in Nashville, hospital companies are the dominant player, and I asked Alexander how his goals are informed by those companies' experience. HCA Holdings, LifePoint Hospitals and Community Health Systems have reported early benefits to their bottom lines from the increased number of patients with insurance coverage, either via the online marketplace or Medicaid expansion in states that chose to expand the program.

Alexander acknowledged hospitals have budgeted for a larger number of covered lives, and said the best way to continue to reap those benefits "would be for the Obama administration to be flexible enough to allow Gov. [Bill] Haslam to develop an expansion of ...TennCare that the [state] Legislature would approve."

"As a former governor, I understand Gov. Haslam's caution" not to implement an expansion program that would "bust the budget," Alexander said, noting that TennCare represents more than triple the percentage of the state's budget than it did when he was governor in the 80s. The senator said he has encouraged HHS Secretary Sylvia Matthews Burwell to be as as flexible as possible to make Medicaid expansion in Tennessee a reality.

Outside of reform, Alexander said his biggest health-related priority as chairman of the health and education committee will be to restructure and reform the Food and Drug Administration to make it more responsive to modern times.

"F or example," Alexander said, "in the current ebola crisis, if there's a vaccine or a treatment or a rapid-response diagnosis test that's promising, we need to make it easy for those new ideas to make their way through the FDA process as rapidly as possible and still be safe."