A few Republican presidential hopefuls have offered specific healthcare proposals to replace the Affordable Care Act, or Obamacare.
These plans offer insight into how the Republican Party would lead on the issue of health care. Also, we should hope that these proposals will raise the bar for the field, prompting other Republicans to develop forward-looking answers to the Obamacare question and focusing the horserace on the issues, not personalities.
Not surprisingly, these plans have a great deal in common, and they reflect other healthcare plans that conservative think tanks and legislators have put forward in the past.
They all start by repealing Obamacare. They all devolve power to the state level (especially in the Medicaid program), deregulate private insurance markets, and address the unequal tax treatment of individual and employer health plans.
But the plans have important differences too.
Gov. Jindal’s plan is markedly bolder, eliminating completely the current tax exclusion for employer-provided health benefits and replacing it with a standard deduction for health insurance.
Gov. Walker’s plan puts a cap on this employer-based tax exclusion and uses these revenues to fund (in part) age-rated tax credits for people without an offer of employer-sponsored coverage. Similarly, Sen. Rubio’s plan uses tax credits and limits on the employer exclusion to level the playing field between employer and individually purchased plans. All of these plans aim to create a more robust, competitive health insurance market.
Gov. Jindal and Sen. Rubio endorse a premium-support model for Medicare in their plans. This major reform would allow (future) retirees to opt to use their healthcare dollars to purchase private insurance plans instead of having to participate in traditional Medicare. Gov. Walker plans to deal with Medicare reform separately in the future.
Guests watch Republican presidential candidates speak during the first Republican presidential debate hosted by Fox News and Facebook at the Quicken Loans Arena on August 6, 2015 in Cleveland, Ohio. The top ten GOP candidates were selected to participate in the debate based on their rank in an average of the five most recent political polls. (Photo by Scott Olson/Getty Images)
That said, we should keep in mind that any plan that repeals Obamacare has implications for Medicare because Obamacare contains billions of dollars of reductions to the Medicare budget and the “Independent Payment Advisory Board,” an executive board tasked with controlling Medicare’s budget.
Any of these plans would be an improvement over Obamacare. They’d expand individual choice, foster greater competition among healthcare plans, reduce the incentives to over-insure in employer-centric groups, and increase state autonomy and flexibility for solving health policy problems.
The fact that candidates are releasing these detailed plans is a step in the right direction for the GOP. For too long, liberals have successfully deceived the public into believing that conservatives have no health reform ideas, or that conservatives only want to return to the status quo before Obamacare.
If nothing else, these candidate-sponsored plans may encourage the mainstream media to discuss conservative healthcare ideas. It would be better, and more intellectually honest, for liberals to criticize these plans than to pretend they do not exist.
Even from a truly conservative perspective, none of these plans is perfect. Ideally, we ought to be moving beyond the assumption that our primary health policy goal is increasing comprehensive insurance coverage (or “universal coverage.”) Rather, our focus should be on making health care—not insurance—more accessible and affordable. After all, a primary cause of the problems in our health care system is that we have become so reliant on a third-party payer system that discourages efficiency and innovation.
But politics is the art of the possible. The current system (and the culture surrounding it) is heavily dependent on third-party payment, and most Americans with private insurance have come to expect that their employer will provide this benefit. People would reject any major disruptions, so the less ambitious conservative plans may ultimately be more politically feasible.
These latest Republican plans show that candidates aren’t allowing perfect policy to be the enemy of the good. Americans are frustrated with Obamacare, and need to be reassured that Republicans have workable plans to replace the current law with something better. Conservatives should applaud the efforts of candidates who boldly outline their healthcare solutions, and encourage more discussion of this important issue.
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