When it comes to health reform, perhaps the only thing Congressional Republicans agree on is they hate ObamaCare.
There’s no agreement on a basic framework much less consensus on an actual bill. Moreover, there are parts of ObamaCare that enjoy solid support amongst many Republicans, complicating the GOP’s efforts to develop an alternative without conceding political ground.
Their dilemma is certainly understandable; as anyone who followed the tortuous path of the PPACA (aka Obamacare), there was precious little consensus among the Democrats who passed the bill. While most had serious issues with various bits and pieces, they held their noses and voted “aye” when pressed.
Now that there’s a distinct possibility that the Supremes will overturn part/some/all of reform, there’s pressure on the GOP to come up with an alternative.
Here’s a few of the more contentious issues.
– requiring insurers accept all applicants is favored by most Republicans (according to Politico) but a) some senior Republicans hate the idea and b) there’s zero consensus re how to actually make that work. Do they forbid upcharging for older/sicker people? Adopt some form of risk-adjustment and/or financial transfer among/between insurers based on the risk profile of their members? Or allow the free market to operate, hoping that insurers will somehow figure out how to insure people with pre-existing conditions at affordable rates?
– taxation is a big issue; one bill sponsored by Rep. Paul Broun (R-Ga.) allows taxpayers to deduct all of their health care costs, while others cite the tax-free status of health insurance as a major cost driver. What looks like the leading bill (at least at this point) also uses the tax code to encourage people to buy insurance.
– most GOP-authored bills allow people to shop for insurance across state lines, which seems to be at odds with other GOP concerns that health insurance should be the purview of the states, and the Feds ought not to be involved
– the elimination of coverage for young adults and kids with pre-ex conditions is a concern to Rep Tom Price, who stated: “That would present a significant void and vacuum in health policy…There will be a need to have some things to fill that vacuum.” Again, many first-term Republicans see no role for the Federal government in health care, making any caucus-wide consensus on the issue doubtful.
– most of the plans on offer include some thyme of malpractice reform, however there’s ample evidence that malpractice reform would have a negligible impact – at best – on system costs. (One authoritative study indicated a 10% reduction in malpractice rates was associated with about a 0.132% decrease in the overall cost of care.)
If the GOP decides it must act, the challenge will be to first convince the Tea Part Republicans that Congress has the authority to do so. While the Republican Party used to be pretty disciplined (especially when compared to the Democrats), last summer’s debt-ceiling fiasco was ample warning that Boehner doesn’t control his membership.
If and when that’s done, next step is to come up with a plan that doesn’t look an awful lot like/have a lot of the same provisions in ObamaCare and make sure it actually expands coverage and reduces costs, as scored by the CBO.
This should be interesting…
Hat tip to California Healthline for the head’s up.
May
2
What a dilemma, My Party has a bad track record at healthcare reform. I site medicare part D. There is no way to offer more coverage and pay less. I like the tax free healthcare spending but that does not help the poor. What we need is a systematic change that increases the availability of care or supply side. I would absolutely support Government subsidized medical school for nurses and doctors in exchange for public service in the military and public health systems. By removing the artificial barriers to become a Doctor or Nurse we could increase the availability of medical care and reduce the cost.
If Republicans would go back to their roots on healthcare reform, they would come up with…..OBAMACARE. If democrats were as adept as republicans in “messaging”, this reform should have been labeled right from the start as The Republican Healthcare Affordability Act!
OBAMACARE truly is a Conservative means to health insurance, by using a manage care system. Although I was always against single payee, lets go for it. Remember, this approach was the idea of Sen.Bob Doyle, in the early 1990’s, to counter Pres. Clinton bill.
Joe, thanks for pointing out the tailoring details, as the Republican emperor has no clothes when it comes to real healthcare policy and governance.
There is another reason for expanding the coverage to ‘adult children’ to age 26. Previously the majority of these young adults were being covered via Medicaid. By increasing the age for ‘private’ coverage – a significant reduction in Medicaid eligibles is evident – which saves both federal and state dollars.
Patrick – thanks for the comment.
I wasn’t aware that the majority of young adults were covered via Medicaid. Where did you learn this? My understanding is that most had no insurance whatsoever.