Obamacare

Are These GOP Candidate Health Care Plans Too Little Too Late?

Repeal and replace plans from Walker and Rubio are constrained by five years of Obamacare.

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Republicans are finally coming around to the reality of Obamacare. The problem is that they're five years too late.

Gage Skidmore

Since the passage of Obamacare in 2010, Republicans have repeated the mantra that the health law should be repealed and replaced. But while repeal votes have been plentiful (though not, as Obamacare's continued presence suggests, entirely effective), replacement plans have been few and far between, and GOP leadership has generally shied away from the proposals that do exist.

There are signs that may be changing. Earlier this week, two leading contenders for the Republican presidential nomination, Wisconsin Governor Scott Walker and Florida Senator Marco Rubio, released plans providing basic outlines for how they would replace the president's signature law.

The two plans differ in their particulars and the level of detail they provide, but, broadly speaking, both take a similar approach, proposing to repeal Obamacare in its entirety and then replace it with a system of advanceable, refundable tax credits intended to help people purchase health insurance, and a strengthening of the continuous coverage guarantee to protect individuals with preexisting conditions, so long as they maintain their insurance.

What both of these plans reveal is that, despite the continuing forceful Republican opposition to Obamacare, Republicans cannot escape the gravitational pull of the president's health law. After five years, it has boxed them in, set expectations, and defined the health care debate.

Some conservatives, including, most prominently, Rubio and Walker's fellow GOP presidential candidate, former Louisiana Governor Bobby Jindal, have blasted their plans as little more than "Obamacare Lite" because of their reliance on a universal system of refundable tax credits. Jindal said that under Walker's plan, "a new entitlement is created for every single American human being from the time they are born right up until they grow old and become eligible for Medicare." 

That's very much an overstatement. But both plans share some of Obamacare's premises, namely that health insurance should be widely subsidized through tax credits, and both work from a sensibility shaped by years under the health law. This is what Republican health care reform looks like in the post-Obamacare world.

One thing that's telling about both plans is what they don't say: Rubio's plan was released in the form of a brief op-ed in Politico Magazine; it gives a sense of the basic elements he would employ, but it's more of a sketch than a full-fledged proposal.

Walker's plan is more detailed, but it still leaves a variety of unanswered questions, such as how and whether to mitigate the risks posed to insurers when sicker individuals sign up, and along the same lines, how to allow people to change plans—as Walker promises he would—without allowing them to game the insurance market by buying cheap plans with little coverage, then immediately transferring to gold-plated insurance when they get sick.

The biggest question, though, is how to pay for it all without raising the deficit. The core of Walker's is a substantial tax credit for anyone who signs up for a health savings account under the law, with the amount determined by and individual's age; it's advanceable as well as refundable, meaning that the credit is available even if it's larger than someone's tax liability. As with Obamacare, it's essentially a subsidy, although it goes to individuals rather than to insurers.

And, as we know from Obamacare, providing a subsidy on that scale is an enormously expensive proposition. As Avik Roy, a conservative health policy expert who is currently an adviser to Walker's rival presidential candidate Rick Perry, notes at Forbes, it's likely in excess of $1 trillion over a decade. But Walker offers no clear way to fund it.

Obamacare pays for its coverage expansion through a combination of taxes and reductions to Medicare spending, which could perhaps be used to help fund the new credit. But Walker's plan repeals the health law in its entirety, and specifies no mechanism for funding its central tax credit, saying only that the Walker administration would make improvements to the health care system that would result in offsetting savings.

It is, essentially, a giant magic asterisk promising to figure out how to pay for it all later. Perhaps a President Walker would eventually find a way, as his plan promises. But settling on offsetting spending cuts is enormously challenging in the best of times, since they inevitably mean that someone, somewhere is losing the funding they have, and thus has a major incentive to mobilize against them.

Republicans, meanwhile, have made this even harder by spending the last five years campaigning against Obamacare's Medicare cuts. Indeed, during the 2012 campaign, GOP nominee Mitt Romney explicitly promised to reverse Obamacare's Medicare cuts.

Obamacare made real health care reform more difficult. Republicans, by waiting so long to offer their own alternatives, have made that project even more difficult still.

Indeed, the similarities between the plans suggests how constrained Republicans are in what they can offer. There are differences, of course, but both plans start by repealing Obamacare, but then attempt to find their own ways to provide federally subsidized coverage, and to keep people paying for coverage without an explicit mandate.

Neither, for example, attempts anything along the lines of the radical restructuring put forth by the Cato Institute's Michael Cannon, who has put forth a plan to use extremely large Health Savings Accounts to unwind the third-party payment system encouraged by the existence of health insurance tax credits. Nor does either plan start, as Avik Roy's plan does, by accepting that Obamacare is here to stay, and then attempt to improve it while using it as a vehicle to overhaul the entire entitlement system—arguably a bigger long-term problem than Obamacare. (Rubio does voice support for a Paul Ryan-style premium support system, while Walker does propose some changes to Medicaid.) Both plans work from the same playbook, one developed largely during the age of Obamacare.

I don't mean to say that these new plans are all bad. There are good ideas in both, particularly in the ways they propose to deregulate the insurance market. More generally, they add to the discussion, and, coming from prominent presidential candidates, elevate the issue. Every GOP candidate should offer a plan.

But the two plans we saw this week, and the similarities between them, reveal the consequence of waiting five years to propose an alternative to Obamacare, just as Obamacare was the consequence of the GOP's failure to make health care reform a priority in the years before it passed. The starting point is, inevitably, a world in which Obamacare is already in place, and the debates it has sparked. Yes, they would repeal Obamacare, but they would still be living in its shadow.

NEXT: Are Republicans Becoming the Party of White Identity Politics?

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  1. Since Obamacare mimics a Republican plan, it probably shouldn’t be surprising that the Republican alternatives aren’t all that different.

    1. derp

    2. Since republicans are just democrats with bibles I’m not surprised. When James Madison was president he stated that he could not find a line in the constitution allowing the expenditure of federal tax monies on charity. Being that he wrote it you’d think he would know how it was supposed to work. Nationalized health care, whether through Medicaid or Obamacare insurance companies, is charity. Actually probably 70% of what the federal government has decided was constitutional in the last 100 years is charity. This is what happens when the citizens are allowed to vote themselves government largess, something else Madison warned us about.

      1. I don’t think you can rightly call the health care charity for those who have to pay more for it in taxes than they get in benefits, which is probably most people.

  2. I’ve begun to really tire of the term “Obamacare”. Mostly just because, in typically fashion, President Not My Fault did virtually nothing to conceptualize, develop, and pass it. It was Pelosi, Reed, and the apparatchiks. Not Obama. Cause he’s not a doer. He’s not really even and Idea Guy.

    He’s the definition of a figurehead. The fact that this piece of shit monstrosity has his name attached to it is a testament to his ability to jump on bandwagons and make people think he’s driving. And designed and manufactured the bandwagon himself.

    It’s amazing.

    Anyhoo – PPACA is “Pelosicare”, “Reedcare”, “Sebiliuscare”, “Bureaucracycare” – anything BUT “Obama”care.

    1. I call it “The Unaffordable Care Act.”

        1. Also completely acceptable.

      1. This is completely acceptable.

    2. You’re right. It should be called Block Insane Yomomma-care.

      /Mike M.

    3. “Democratcare”

    4. Romneycare 2.0

      1. derp

        1. Eh, this one’s not derp per se, unless it’s somehow meant to absolve Obama of blame because “Romney did it first!”.

    5. This wasn’t Obama’s fault by any means. The Republicans wanted to hang the thing around his neck and — though the term was coined during the 2008 campaign (in the same breath as RomeyCare, McCainCare, HillaryCare 2.0, etc.) — started screaming it as a derogatory insult in 2009/10.

      1. Correction. “This wasn’t ENTIRELY Obama’s fault by any means.”

        Republicans (though often scum) simply gave Obama credit that he claimed was his. The fact that it didn’t turn out to be as popular as Democrats expected, or as easy as Democrats expected, caused Obama to not want his name associated with it. Unfortunately for Obama, it was already too late.

        Oh, and it IS a derogatory insult.

    6. DeceptiCare!

  3. Help me out here. How is this an overstatement:

    “a new entitlement is created for every single American human being from the time they are born right up until they grow old and become eligible for Medicare”

    of this

    “health insurance should be widely subsidized through tax credits, “

    1. I guess it depends on what “widely subsidized through tax credits” means.

      The wife and I make a decent amount of income. My bet is that I would not qualify for a tax credit for the health insurance we purchase, but we would get a tax deduction. But even if we did get a credit, is letting me keep more of the money I earn in return for spending it on Health Insurance a subsidy?

      I don’t like Tax Credits because when they result in payments back to the taxpayer (because the credit exceeds their tax liability) they end up cloaking “payments” in our income tax scheme. But if the tax credits phase out relatively quickly (i.e. as your income goes past the poverty level) then it won’t be a massive entitlement.

      I dislike calling a tax-break a Subsidy. Letting people keep the money they earn is not giving.

  4. Help me out here. How is this an overstatement:

    “a new entitlement is created for every single American human being from the time they are born right up until they grow old and become eligible for Medicare”

    of this

    “health insurance should be widely subsidized through tax credits, “

  5. It was Pelosi, Reed, and the apparatchiks.

    Let’s not deny Ambassador Baucus credit.

  6. Scott Walker is not an attractive man

    1. Evidently we don’t care about attractive this election

      1. You shut your whore mouth! We always care about hotness.

        1. I just hope the Democrats don’t figure out how easy it will be to get the libertarian vote if they just start running attractive women

          1. You need a hot woman Prez/VP combo. I’d vote for that.

            1. Kirsten Gilibrand is still looking good. She should run.

          2. Hmmm, they run stupid women. That seems to work.

  7. The biggest question, though, is how to pay for it all without raising the deficit.

    Actually, that’s the biggest problem, and it doesn’t have a solution. The ACA proposed the theory that government should pay for individual health care, and if this is the starting question, people have bought the idea.

    The problem has no solution because the government has nothing to pay health expenses with except tax money, and any system run by government will cost more than people would pay for their own healthcare, and probably much more. And won’t work nearly as well.

    1. So, wait, you’re saying it’s not possible to spend more money, without spending more money?

      BOO THIS MAN.

  8. The biggest question is,
    “WHY DO ALL THOSE LYING BASTARDS CONTINUE TO PRETEND THIS HAS ANY SUBSTANTIVE EFFECT ON THE QUALITY OR PROVISION OF HEALTH CARE SERVICES?”

    1. Uh, votes, money, votes=money.

  9. The Republicans had healthcare reform ideas from the get go that were rejected outright by the Democrats/Obama. Then the media repeated over and over how the Republicans had no alternative. So, I reject the premise of this article.

    Beyond that, the best alternative to Obamacare is the government doing less, but this doesn’t pass as a ‘plan’ to most people. Reform means the government doing more.

    1. I think the GOP should use their good work on School Choice to design a plan for healthcare reform. They have been winning on the argument that funding should be at the discretion of the consumer- the child and their parents. Whether that boils down to vouchers or some other system, it is working and the public is largely behind it.

      My simple proposal:
      1) Everyone gets Health Savings Accounts – money put into these accounts up to some maximum is tax deductible as is the interest or other gains they make in the plan. Just like an IRA, except you can withdraw for any medical expenditure.
      2) In addition to the limits for HSA deposits, you may also deduct the premiums of a High Deductible (i.e. catastrophic) insurance plan
      3) People can still buy more comprehensive coverage (cadillac plans) but the premiums above the cost of a HD plan is not tax deductible.
      4) For the truly needy, the government can deposit funds into the plan that a person can use to pay premiums for the plan as well as medical expenses.
      5) Insurance is required to pay for pre-existing conditions, after an exclusion period (e.g. first 6 months of the plan being active).
      6) Healthcare Cost Insurance will be tax deductible.

      Is it libertarian? No. But it does deal with the perverse incentives of plan-switching for pre-existing conditions, provides a safety net for the truly needy and puts money back in the control of consumers.

    1. It’s hard not to f**k with them.

      Don’t fuck with the mouse.

    2. I think the Princess Diana/Cinderella one is pretty good.

    3. Hack?! It’s f’in’ hilarious!

  10. I have a plan: Repeal, get government out of health insurance and medical services, then radically deregulate insurance and healthcare.

    1. You’re crazy.

      He’s crazy.

    2. HAHAHAHAHAHA!

      THIS IS WHAT RETHUGLIHADISTARIANS ACTUALLY BELIEVE!!1!111

    3. ProL’s suggestion would work very well but it would greatly decrease government power and money and that is why it will never happen.

      The government will just keep feeding itself until they have completely ruined our healthcare system.

      1. It’s like a giant union.

  11. radically deregulate insurance and healthcare.
    .
    Let’s just feed the old and infirm into woodchippers, then. That’s what you obviously want.

    1. I approve this message.

    2. Naaa, people in woodchippers are too messy, and they don’t mulch well.

      1. Speak for yourself.

        *nose in the air*

  12. “…, just as Obamacare was the consequence of the GOP’s failure to make health care reform a priority in the years before it passed.”

    Well, I can finally agree with something Peter writes. Indeed. Cannon’s plan for health savings accounts has been proposed by the right for years, and when they controlled both houses and Bush was President they did nothing. This word “repeal” is a complete non-starter now. Good to see you embrace reality. Fix it, change how you pay for it, whatever. But stop with the “first step is to make the millions who gained insurance through the ACA lose their insurance.” Ain’t gonna happen.

    1. See, I think that’s a load of crap. Its a way of trying to make the Republicans responsible for a failure that they opposed and voted against, unanimously.

      OCare is a consequence of nothing other than the Democrat’s desire to take over the healthcare sector. Period. Full stop.

      You might as well say that somebody running a red light is a consequence of somebody else filling the gas tank the day before.

      But stop with the “first step is to make the millions who gained insurance through the ACA lose their insurance.”

      You realize those (relatively few) millions who gained private health insurance after the ACA passed would have all gotten insurance without the ACA, right? The increase in private insurance enrollment tracks the increase in jobs created pretty closely. Now, as a dishonest marketing ploy by defenders of the ACA, it will probably work, because people are stupid. But as a reflection of reality? Not so much.

      1. “OCare is a consequence of nothing other than the Democrat’s desire to take over the healthcare sector. Period. Full stop.”

        I would add that it was done not for the sake of healthcare but for the sake of power and control. It really is evil in its intent and function.

      2. Roughly 10m gained insurance, not a small number. And the rate of those uninsured is at historic lows already, and still dropping since the ACA. Look at the graph on this page

        http://time.com/3639785/uninsu…..re-record/

        The fact is that reform on health care has been needed for decades. Something was goi g to get done, it wasn’t going to continue. It’s why the GOP talked about health savings accounts in response to Dem plans, like Clinton’s. They knew full well something had to change, but they sat on their hands.

        1. The democrats are responsible 100% for Obamacare. No one is buying the excuse that it is the fault of the republicans for doing nothing. The health savings accounts were not in response to the democrat’s plans, they have been talking about that for decades.

          The greatest evil in this power-grab is the government acquiring the power to compel people to engage in commerce that they would not have otherwise. To be rid of that I would uninsured every single person in the country.

          The broccoli mandate is coming and it is coming because of Obamacare and its fuckwit supporters like you.

          1. And it is noteworthy that during the Bush Administration and during the GOP-Controlled congress of the Clinton Years, there were numerous reform bills- including the advent of HSAs- passed by the GOP.

            The GOP did not deal with Pre-Existing Conditions. That was their great “failure”. And to deal with the relatively small proportion of americans with Pre-Existing Conditions, the Democrats appropriated the entire health insurance sector.

            To say this is the GOP’s fault is absurd. It is saying that it’s my wife’s fault I converted my basement to a $50,000 home theater because she didn’t keep the kids from cluttering the living room DVR with Goddamn Paw Patrol recordings.

        2. Jackoff, you are a Jacka$$.

          Stealing from some people so as to keep some and give the rest to others is wrong. It is always wrong. It is always evil. You as an advocate of stealing are evil.

          I am starting to rethink my stand on opposing people going into woodchippers. You would make a mess, but you are making a mess now.

          1. At least the resulting mess would serve as…mulch?

        3. Roughly 10m gained insurance, not a small number.

          Many to most of those were added to Medicaid, which is welfare, not insurance, and could have been expanded without seizing control of the private insurance market.

          Of those that did gain private insurance, remember you first have to account for the 5mm who lost insurance as the law went into effecgt, and then account for those who gained insurance from new jobs.

          After all that, the best you can say is probably that the number of people on private insurance was largely unaffected by OCare.

          1. “After all that, the best you can say is probably that the number of people on private insurance was largely unaffected by OCare.”

            And not even that much really; I had private insurance that for some mysterious reason I didn’t get to keep, which had to be replaced with a private policy (I refuse to buy an exchange policy on principle) that costs me roughly 145% more for annual premiums and 235% more if my higher deductible is included.

            I have no ability to understand those who so willingly accept the ends regardless of means. We’ve all been lied to by these charlatans (politicians of both parties, but D in this context) and yet most will still believe it will be different next time.

            Holy Crap Charlie Brown! Get a clue!

        4. My wife and I had insurance before this Democrat abortion went into effect. Now we have to buy it through the marketplace. Multiply this scenario by millions of employees who lost their insurance BECAUSE OF THIS LAW, and your 10m (which is still 1/4 to 1/3 of the number of people that it was supposed to insure if you take that number at face value, btw) and that number drops considerably.

          Basically: Go fuck yourself.

  13. But stop with the “first step is to make the millions who gained insurance through the ACA lose their insurance.” Ain’t gonna happen.
    .
    As people find out (the hard way) just how shitty the coverage is, they’ll ask themselves what they’re really paying for, and stop paying their premiums. A lot of those newly insured will drop out. Obamacare will collapse of its own weight.
    And, That hasn’t happened yet” not same as “That will never happen.

    1. The trend is the other way. The most recent Kaiser poll says 44% approve of the ACA and 41% don’t. And that includes 28% who think it isn’t strong enough

      http://kff.org/health-costs/po…..gust-2015/

      Many people like Peter have been predicting it would collapse years ago, and it only has gotten stronger.

      1. just imagine when we get single payer and your doctor is a government hack employee like joe bitching about the host every day.

      2. ok, I give in, Fire up the woodchipper for Jackoff Ass.

      3. Many people like Peter have been predicting it would collapse years ago,

        We’ve been predicting for years that it would collapse, not that it would collapse years ago.

        Those of us who have a clue know what a death spiral looks like, and can recognize that we are in the beginning-to-middle stages of one for the HIE products.

        2016’s enrollment will be critical, as this is the year that the higher risk of the HIE pool gets reflected in the premiums. Those premiums are looking like they will be a lot higher (early stage death spiral). IF enough people bail because of the higher premiums, that risk pool is going to get even more toxic (middle-stage death spiral).

        The only way to stop it, of course, is more and more and more subsidies. Yay, markets!

      4. Why is it that you interpret the results like that?

        I interpret them to mean that like the victim of a violent rape, people have begun to accept that it happened, the authorities they were told to trust did it to them and will do it again on a whim, they are left to deal with the fallout on their own, be it pregnancy or disease. Oh, and we got to pay for the privilege.

        Is that the trend you mean?

  14. OT: this EPA shit is beyond the pale:

    In late 2005, the EPA collected tons of sludge from two Leadville mines and secretly dumped it down the shaft of the New Mikado mine without notifying Hennis, its owner, according to documents reviewed by Watchdog.

    A drainage tunnel had been installed at the bottom of the mine shaft by the U.S. government in 1942, meaning that any snow or rain would leach toxins into the surrounding land.

    Despite that history of bitterness, in 2010, the EPA asked Hennis to grant its agents access to Gold King Mine in Silverton because the agency was investigating hazardous runoff from other mines in the region.

    “I said, ‘No, I don’t want you on my land out of fear that you will create additional pollution like you did in Leadville,'” Hennis said. The official request turned into a threat, Hennis said: “They said, ‘If you don’t give us access within four days, we will fine you $35,000 a day.'”

    1. What do you expect to happen in Leadville?

    2. Idle hands said: “this EPA shit is beyond the pale”

      Well, just maybe:

      “In your dream, the EPA is not a scam”
      “In your dream, Obamacare is not a scam”
      “In your dream, the Federal Reserve is not a scam”
      “In your dream, Social Security is not a scam”
      “In your dream welfare is not a scam”
      “In your dream, the constitution was not a scam”?

      Original music and lyrics: “Dreams[ Anarchist Blues]”:
      http://www.youtube.com/watch?v=w0o-C1_LZzk

      Dream on, Idle Hands?

      Regards, onebornfree.
      Personal freedom therapist
      onebornfreeatyahoodotcom

  15. I don’t want you on my land out of fear that you will create additional pollution like you did in Leadville
    .
    That’s crazy. They PROTECT the environment, It’s right there in their name, for crying out loud. They’re, like, from the government and everything. What a paranoiac wingnut.

  16. It’s all a scam, folks; the Demoscams, the Republiscams”, the whole frickin’ shebang:-)

    However for some here:

    In your dream, Obamacare is not a scam”
    “In your dream, the Federal Reserve is not a scam”
    “In your dream, Social Security is not a scam”
    “In your dream welfare is not a scam”
    “In your dream, the constitution was not a scam”…….”

    Original music and lyrics: “Dreams[ Anarchist Blues]”:
    http://www.youtube.com/watch?v=w0o-C1_LZzk

    Regards, onebornfree.
    Personal freedom therapist
    onebornfreeatyahoodotcom

  17. Anyone that even proposes a Federal government replacement isn’t fit for office.

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  19. These guys have a problem: they are using two words too many. REPEAL is the ONLY word of any significance. Repeal, and let the FREE MARKET deal with it. Government never can fix it. Not supposd to, in fact, are prohibited from dealing with healthcare at all… see the Constitution where it assigns about 18 tasks to FedGov, then tAKES AWAY all the others, prohibiting FedGov from dealing with them. Insurance, medical care, etc, are NOT on the “enumerated Powers list….

    1. Indeed. Right from the start of the Unaffordable don’tcare Act, when there was immediate talk about “repeal and replace,” my instant reaction was unless replace means replace with the free market, that isn’t the correct answer. The answer is simply, repeal. No government replacement needed.

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