House speaker Paul Ryan said Wednesday that the House GOP’s new Obamacare replacement is focused more on quality than quantity.
That’s true, as far as the substance goes. But as far as the number of proposals in the health care package is concerned, quantity doesn’t take second place to anything.
The comprehensive platform released as part of Ryan’s “A Better Way” agenda unifies several Republican priorities from recent years with a couple of popular Affordable Care Act carryovers. It counters a central Democratic critique of the GOP—that its only health-care idea has been to eliminate the president’s health-care law—and aims to encourage a competitive insurance market that suppresses costs and ups the quality of care.
“And that starts with giving you a choice. Instead of forcing you to buy a plan that Washington bureaucrats have mass-produced, we’re going to repeal those mandates and let you pick a plan that works for you,” Ryan said at the American Enterprise Institute. “We’re saying, don’t force people to buy insurance. Make insurance companies compete for our business.”
Such a market-oriented focus begins with a repeal of Obamacare, as well as some familiar Republican ideas: allowing insurance sales across state lines and expanding access to personal health savings accounts, which consumers could use at their discretion to obtain care. But the Obamacare replacement provides some direct alternatives to what the law offers: Instead of a premium-support subsidy to purchase government-approved insurance, for example, the GOP program would provide a refundable tax credit to help individuals without access to job-based insurance receive coverage. The credit is age-adjusted and favors older individuals, and it would grow over time.
The credit would be paid for by capping the tax-exclusion for employer-sponsored insurance, making generous plans taxable—something that Republicans say differs from Obamacare’s “Cadillac tax”, which penalizes workers regardless of income for possessing pricey insurance that the health-care law itself is responsible for making more costly.
While one of the GOP approach’s pillars is repeal of the Affordable Care Act, it would also retain a couple of the law’s more well-received provisions: allowing dependents up to age 26 to remain on their parents’ insurance, and preventing insurers from denying coverage to individuals with preexisting conditions.
All told, it’s an ambitious agenda.
“I think the House proposal brings together a lot of the best conservative thinking on health care developed over the past decade, and makes for a serious and fairly comprehensive alternative approach,” Yuval Levin, the editor of National Affairs, tells THE WEEKLY STANDARD. “It highlights a key difference between left and right on health care: The left wants to strictly define the insurance product and then compel insurers to sell only that product and compel consumers to buy it. The right thinks we can reach a better system by allowing for a much greater variety of choices and options and genuine consumer power. I think what the House Republicans put forward today would be a huge step toward a functional health insurance market.”
And as Levin added, the package also takes an “admirably assertive” approach to Medicare reform. Notably, it would raise the Medicare eligibility age to match that of Social Security, 67, starting in 2020, and it would also allow seniors to select among private plans on a newly created Medicare Exchange beginning in 2024.
True to the proposal’s wide scope, it also addresses some conservative social policy, like enacting conscience protections for caregivers and preventing federal dollars from flowing to abortion services, and applies conservative policy preferences on such issues as regulation to encourage innovation in research and development of treatments.
“It recognizes that health care today is a wholly integrated system, consisting of providers, insurers, researchers, entrepreneurs, and others working to deliver the best quality care,” the document states. “Our proposal embraces this reality but also recognizes that people must come first. A health care system is only as good as its service of the patients who rely on it.”
