While congressional Republicans have busied themselves voting 47 times to repeal Obamacare, they have long failed to offer a competing vision for health reform. We all know what they’re against, but what are they for? Heck, can they quell their own infighting long enough to agree on what they’re for?
Yeah, some Republican visions have surfaced on occasion, but only to land in limbo. A Georgia congressman has tried several times to tout his “Empowering Patients First Act,” but half of the House Republicans have refused to sign onto it, and the GOP leadership has never even brought it up for a vote. Apparently the party has had trouble getting its act together on an affirmative health reform plan of its own – which is no surprise. As a Republican aide recently told conservative political reporter Byron York, “Getting unanimity is a tall order for a divided, leaderless party.”
But hang on…what do we have here…a brand-new Republican reform plan! It’s the work of Senators Orrin Hatch, Richard Burr, and Tom Coburn, it was unveiled earlier this week, and it has a nifty name: The “Patient Choice, Affordability, Responsibility, and Empowerment Act.” The idea is to give Republicans something substantive to talk about, so that on the distant day (Republican president, filibuster-proof Republican Senate, Republican Congress) when Obamacare is presumably repealed, a replacement plan would be ready for liftoff.
Problem is, this plan would blow up on the launchpad. Big surprise.
Just imagine how Republicans would’ve reacted if President Obama had floated a reform plan that required 150 million Americans to pay income tax on roughly 35 percent of their employer-sponsored health coverage. Republican heads would’ve detonated at the prospect of an “Obama tax hike,” and their trolls would’ve imploded.
And yet, that big tax hike is baked into the new Republican recipe. I kid you not.
Eighty five percent of Americans get their health coverage on the job; the coverage has long been totally tax-free. But the Republican reformers would do away with that. They envision capping the tax exclusion at 65 percent of the average plan’s cost. The consumer would pay income tax on the rest. Basically, the GOP vision would trigger one of the biggest middle-class tax hikes in decades.
Granted, there’s a rationale for the tax hike. First, the reformers believe that if people are essentially paying more for their coverage, they’ll have the incentive to shop for cheaper plans with higher deductibles, and shop for cheaper tests and treatments. Second, they want to use the new tax revenue to fund subsidies for the uninsured. In other words, a tradeoff.
Are these guys funny or what? Rest assured that if Obama, at the dawn of the health reform debate, had said, “We’re gonna slap a tax hike on folks who get their coverage on the job, and use that money to help the uninsured,” Republicans would’ve scoffed at the tradeoff and simply ratcheted up the hate. “Obamatax” would’ve been the robotic mantra of 2009.
But never mind the daunting political challenge of replacing Obamacare with a plan that taxes on-the-job health coverage. (Would tax-hating conservative lawmakers really vote for that? The right-wing Daily Caller already hates that tax.) Just take a gander at this Republican reform goodie:
Insurance companies would no longer be required to cover all Americans with pre-existing health conditions (that requirement is a linchpin of Obamacare). Only those people who have managed to remain continuously insured would still be guaranteed protection (an idea floated by Mitt Romney in 2012). But anyone with lapsed insurance and a pre-existing condition could again be denied coverage – either that, or the insurance companies would be free to charge a prohibitive premium.
Still, here’s the really funny part: The Republican visionaries would keep some of the key features of Obamacare – like the provision that bars insurers from capping their payments to expensively-sick customers, and the provision that allows young adults to stay on their parents’ plan until age 26. You know, stuff that wouldn’t be settled law if Obama hadn’t championed health reform; stuff that wouldn’t settled law if Republicans had been running the show. (By the way, a newly-released Kaiser Family Foundation poll says that 55 percent of Americans view Obamacare as settled law and want it improved, not repealed.)
Indeed, nothing happened when Republicans ran the show. As Avik Roy, a senior fellow at the conservative Manhattan Institute, says on the Forbes website, the GOP’s politicians “have often been the most complacent” about reforming the health system, because, historically, they “have had little electoral incentive.” As he rightly points out, “the vast majority of the Republican base is employed or retired,” and therefore content with the status quo.
Hence the inertia during the George W. Bush era; for much of that time, the Republicans controlled both chambers. That’s when they should’ve moved on their own vision of health reform, or at least spent the political capital to frame reform on their terms. Instead, Obamacare filled the vacuum – and any future GOP replacement plan would necessitate canceling the tens of millions of people newly covered at that point by Obamacare.
It almost doesn’t matter what the Hatch-Burr-Coburn vision says, because, in politics as in life, timing is everything. On health reform, Republicans tarried far too long. They had their shot, and they blew it.
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