The race for the Republican nomination for president is obviously well underway.
The first debate is in less than three weeks - in Milwaukee, Wisconsin.
The candidates have largely been silent on healthcare.
That's a strategic error. Nine in ten people are concerned about increases in the cost of health care, according to polling from the Kaiser Family Foundation.
Democrats have been clear that they want the federal government to forcibly control healthcare costs.
That will lead to long waits, rationing, and reductions in access to innovative care.
The GOP needs to present an alternative vision.
A new report from the Hoover Institution — "Choices for All: Healthcare Reforms for the Future" — offers one such vision.
"The key is to put more decisions in the hands of patients," the report's authors write. The Republican presidential field might consider adopting it as a rallying cry.
What might "more choices for patients" mean in practice?
According to the Hoover report, "[it] means introducing meaningful prices into the system.
"It means fewer supply-side regulations that limit the supply of hospitals or providers."
Finally, "it means finding new, innovative ways to deliver insurance and medical care that better meet the demands of patients."
One of those ways is something Republicans have actually been championing for some time — "association health plans," or AHPs.
Under these arrangements, independent contractors, self-employed people, and small employers within the same industry or profession band together to purchase coverage in the large-group market, as if they were one big employer.
That gives them more buying power.
After all, there's strength in numbers.
An AHP might have the scale to extract a better deal from an insurer than an individual member of that AHP would be able to on its own.
Consider that average individual deductibles for firms in the small-group market were roughly 28% higher than in the large-group market in 2021.
For family plans, the average deductible in the small-group market was 32% higher.
In other words, AHPs could make higher-quality coverage available to sole proprietors or independent contractors than they could get in the individual market.
Small firms that may not have the funds to sponsor health insurance on their own could link their employees up with an industry-specific association health plan — and even provide an assist with the premiums. Their workers, meanwhile, could conceivably take their coverage to another job within the industry.
AHPs "for rideshare service employees, restaurant employees, or whole construction industries," are among the possibilities the Hoover report envisions.
Making association health plans more widely available would require amending the Employee Retirement Income Security Act of 1974, which defines employer and association narrowly.
States also jealously guard their insurance markets; that's made multi-state association health plans a virtual impossibility.
Two years ago, Republicans in both the House and Senate introduced bills that would have allowed associations to sponsor fully insured health plans as if they were large employers.
But those efforts went nowhere.
Independent contractors, self-employed people, and employees of small businesses have long lacked adequate options for health insurance.
Even so, the ranks of these groups are growing, thanks in part to the rise of the gig economy and the growing desire for more flexible work arrangements.
Association health plans could offer these individuals better coverage at lower cost.
The Republicans running for president should put AHPs at the center of their healthcare agenda — and propose to make them widely available nationally.
Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is "False Premise, False Promise: The Disastrous Reality of Medicare for All," (Encounter Books 2020). Follow her on Twitter @sallypipes. Read Sally Pipes' Reports — More Here.
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