• Quote: GOP abuzz with ACA tweaks, replacements

    Republicans are considering several ideas for how to proceed. [Republican Senator Ron] Johnson argued that Congress should do away with the mandate that most people obtain insurance, but not the online exchanges at the heart of the law. Instead, he said, the options in the marketplaces should be augmented by other choices that fall short of the law’s coverage standards, such as catastrophic health plans. […]

    Senator Kelly Ayotte, Republican of New Hampshire, said she was teaming up with Democrats on a host of incremental changes to the law, such as expanding health savings accounts and repealing a tax on medical devices. And other Republicans are wondering aloud how long they can keep up the single-minded tactic of highlighting what is wrong with the law without saying what they would do about the problems it was supposed to address.

    Representative Tom Price, Republican of Georgia, a physician and a prominent conservative voice on health care, is pushing what he calls the Empowering Patients First Act, which would repeal the health care law but keep its prohibition on exclusions for pre-existing conditions in private health insurance.

    The bill would allow for insurance to be sold across state lines, push small businesses to pool together to buy insurance for their employees, expand tax-free health savings accounts, cap malpractice lawsuits, and offer tax credits of $2,163 for individuals and $5,799 for families to buy health plans.

    The American Action Forum, a conservative advocacy group run by Douglas Holtz Eakin, a former director of the Congressional Budget Office, analyzed the Price plan this month. The group concluded that it would lower insurance premiums by as much as 19 percent by 2023, while leaving the ranks of the uninsured about five percentage points higher than the Affordable Care Act would by then.

    Representative Paul D. Ryan of Wisconsin, the Republican vice-presidential nominee in 2012 and a possible 2016 presidential hopeful, is preparing his own health insurance plan for release early next year.

    Mr. Ryan’s plan will build on one that he and Senator Tom Coburn, Republican of Oklahoma, introduced in 2009, according to aides familiar with it. The proposal, called the Patients’ Choice Act, would have eliminated the tax break for employer-provided health care to finance a tax credit of about $5,700 for families and $2,300 for individuals. States would have been asked to create insurance marketplaces like the ones many have created under the Affordable Care Act.

    As with the Obama health care law, the Ryan proposal demanded that insurers meet minimum standards of coverage and be prevented from excluding the sick. But instead of mandating penalties for failing to buy insurance, the approach would have automatically enrolled people unless they opted out.

    Jonathan Weisman, The New York Times.

    It being an election year, the safe money is that nothing of significance becomes law. The caveat would be if the ACA clearly and badly fails in more than a few states and for reasons beyond the control of those states (refusing to expand Medicaid hardly counts). Frankly, I don’t think that we’ll be able to make that assessment until next year.


    • They will do nothing whoch actually helps ordinary people. Pleasenote that after 1993, their ideas for reform were……. Nada.

    • I get the impression that the ACA , for all its faults which may even turn out to be fatal, has been paradigm changing. We are no longer hearing that the US has the best health-care system in the world with the exception of some commenters on this website. Now, the Republicans are concerned by people being without insurance and offering plans to regulate the pre-existing conditions clauses. All of these Obamacare Lite and Obamacare with a twist plans listed in your article did not exist before. I do not think that this turn in thinking will be reversed easily even if the political tennis match continues at its current level of ferocity.
      The preObamacare world is gone.

      • ???

        All of these ideas have been around on the free-market/conservative side for quite a while, with the exception of Price’s plan to bar insurers from considering pre-existing conditions (one reason that hasn’t been offered in the past is that it’s a terrible idea). I remember listening to Obama demagogue in a debate on McCain’s idea for tax credits to purchase insurance in place of the tax exemption for employer-provided insurance (this, IMHO, was what proved to me beyond a shadow of a doubt that Obama didn’t know jack **** when it comes to health care policy since getting rid of the employer exclusion is probably the single biggest area agreement between the right and left, at least among the policy community).

        • “Article 35. Citizens of the People’s Republic of China enjoy freedom of speech, of the press, of assembly, of association, of procession and of demonstration.”

          You could make the argument that “All of these ideas have been around in the PRC for quite a while, China always had press freedom, why is it suddenly a big deal if they talk about opening up?”

          Similarly, all of these conservative plans have been around for over twenty years, but, even when they controlled all of the levers of government they were never implemented or even moved towards. “We said it first” means jack when someone else actually DID it first..

        • I don’t dispute anything you say, Mr. Parnell. I do not claim that there is anything original about the ACA; I don’t even claim that the ACA is good/useful. But I do think that the conversation has been changed. I graduated from med school in1971 and have served on the boards of two insurance carriers. If the Republican side was worried about people being without insurance or insurance being very costly, it flew under my radar. Now I hear about it loud and clear. It is certainly possible that I have been asleep and inattentive, but I think there has been a big change in the dialogue which I think will not be transitory even, or maybe especially, if the ACA fails.

          • I will agree with you that the conversation has changed, and I’ll also agree that Republican leadership has not made health care a priority.

            Several years ago I was at a conference of free-market policy people and a Republican member of Congress for whom health care was a priority explained that he’d gone to leadership and laid out a series of policies that he thought they should push through – standard stuff, like expanded HSAs, tax credits for the uninsured, tort reform, interstate sales, association health plans, high risk pools, etc. He told us that leadership’s response was “Health care reform? That’s a Democrat issue.”

            Well, if you’re going to cede the issue to the other side, then you shouldn’t be surprised when the other side prevails. So I’m all too aware that Republicans didn’t put much of a priority on this issue before, and that a great deal of the current activity is based on “Oh, ****, we ignored this when we were in charge and now we really have to do something about it.” That’s politics, of course – I’m sure you could find similar issues where Democrats ignored serious problems for a long time and then woke up one day and discovered that Republicans had taken care of it for them (welfare reform comes to mind).

    • I have been waiting since 2007 for someone to actually cost out the tax credits.

      Back of the envelope, I come up with about $600 billion a year in new health care credits.

      Meanwhile, if every single employer that now provides health insurance keeps providing it, and these premiums are taxable to employees, the revenue to the feds total about $250 billion.

      I do not mind being schooled on this, maybe Holtz-Eakin has published some numbers on this.

      By the way, some of the items noted in this post are almost comical.
      How would cancelling the medical device tax mean anything for national insurance?

      And as for the old chestnut about state lines —
      if all statesadopt guaranteed issue, this ‘reform’ is meaningless.
      The state-lines routine was an old and shabby tactic to help young people in the five guaranteed issue states pre-2014 buy underwritten coverage in the other states.