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Debate over how to repeal and replace the so-called Affordable Care Act (Obamacare) is all the rage now in Washington, D.C. What about outside of D.C.? The questions that I have heard most from my constituents are:

Will the federal government still require coverage for pre-existing conditions?

Will the poor still have access to coverage?

It should be pointed out that it is a false narrative to assert that we need to replace Obamacare at all. In fact, our U.S. Constitution does not grant the federal government any authority over health care policy. Until our executive, legislative and judicial branches in D.C. start paying attention to the Constitution, however, it is of practical necessity to address what happens in the wake of Obamacare’s repeal.

How should we best address pre-existing conditions? First, we need to recognize that insurance is supposed to be a financial tool for managing risk. Risk denotes that something might happen. Once it does happen, it is no longer a risk. It is an issue. A pre-existing condition is a health care issue — not a risk.

Coupling insurance to pre-existing conditions has been a scam since it was first proposed. Its proponents were attempting to squeeze a square peg into a round hole because the round hole of insurance had the initial appeal of a much lower cost. Eventually, the real world catches up to this charade and insurance costs skyrocket, which is what we are experiencing today.

If we were to truthfully address pre-existing conditions, we would focus on lowering the cost of delivering the medical services required to treat those conditions, not toss the problem over the fence to insurance companies or continually growing unsustainable government programs.

One way of lowering costs is to provide such medical services under a Direct Primary Care Services (DPCS) service agreement. Because DPCS is not an insurance product, these agreements make no distinction between patients with pre-existing conditions and patients without them. The industry average for these agreements runs between $25 and $85 per month. DPCS frees doctors from costly red tape due to third-party regulations. Health care decisions are between a doctor and patient.

So, how can we best provide access to care for the poor? First, we have to recognize that the current Medicaid program does not work. In fact, there are even Medicaid enrollees who pay $50 a month for access to DPCS because they cannot find a primary care physician who takes Medicaid (due to low reimbursement rates). We need to cut the federal strings that exacerbate this problem so that Michigan can design a program that works.

Block granting of Medicaid funds to states without such strings would allow states like Michigan to bundle DPCS into our Medicaid coverage, foregoing the need for enrollees to make such contributions to get access to a doctor. People would get better care, spend less time in hospitals, and Michigan taxpayers would benefit from over $3.5 billion per year in savings.

It turns out that we don’t need Washington, D.C., to micromanage our health care decisions at all.

State Sen. Patrick Colbeck, R-Canton, represents Michigan’s 7th Senate District.

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