More clues about what GOP’s “repeal and replace” really means

Suppose Mitt Romney wins the presidential election this year, and Republicans have the opportunity (perhaps with the help of the Supreme Court) to replace the Affordable Care Act. What would they actually do?

Writing in National Affairs, James Capretta and Robert Moffit have now provided what is probably the best available roadmap to Republican proposals. At least these authors provide the best available roadmap for what Republicans would try to do, since some components of their plan seem unlikely to pass Congress. Judging by this appearance by Mitt Romney on Jay Leno, Capretta and Moffit capture the core elements of what a proposed RomneyCare might look like. So their article commands attention.

Capretta and Moffit deserve credit for presenting a fairly explicit blueprint. For obvious tactical reasons, Republicans have talked much more about  the “repeal” part—on which all Republicans agree–than about the nuts and bolts of what “replace” actually means. Rather little explicit policy analysis has emerging from Republicans during the Obama presidency. Meanwhile, familiar technocratic figures within health policy such as Mark McLellan and Gail Wilensky seem conspicuously marginalized within an increasingly conservative Republican policy conversation.

Six critical passages deserve attention:

  1. The first crucial component of any serious reform must be a “defined contribution” approach to the public financing of health care.
  2. For market forces to work, consumers must be cost-conscious. Those who decide to consume goods or services must face tradeoffs that require them to prioritize the various uses of their money.
  3. In the context of employer plans, this approach would mean moving away from the unlimited tax break that is conferred on employer-paid premiums, and instead providing directly to workers a fixed tax credit that would offset the cost of enrollment in the private insurance plans of their choice.
  4. If you stay continuously enrolled in health insurance, with at least catastrophic coverage, you will never again face the prospect of high premiums associated with developing a costly health condition.
  5. A replacement plan must be true to the Constitution and reflect a genuine federalist philosophy.
  6. While Medicare reform is absolutely essential… it need not be enacted in the same legislation as an Obamacare replacement program. This is true especially because a replacement program would be focused primarily on providing an alternative vision of insurance coverage for working-age Americans, not retirees.

I’ll have more questions and comments about these passages in some subsequent posts.


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