Some Republicans vying for president have a different political calculus on Obamacare than their counterparts in Congress.
For years, GOP leaders have shied away from offering a specific plan to replace President Obama’s healthcare law, instead sticking to criticizing the sweeping measure without attaching themselves to specific proposals that Democrats could attack.
But on Tuesday, top presidential contenders Wisconsin Gov. Scott Walker and Florida Sen. Marco Rubio released proposals to replace the Affordable Care Act. Walker laid out a relatively detailed list of ideas in a 15-page document, while Rubio presented a handful of broad changes in a Politico op-ed.
In doing so, they join Louisiana Gov. Bobby Jindal as the only three of more than 15 contenders to propose Obamacare replacement plans — a move that, this early in the election season, surprised some political analysts.
“I’m surprised at this stage, only because it’s a lot of specificity,” said health economist Gail Wilensky, a longtime adviser to Republicans. “Usually you only get in trouble by having more specificity when you’re trying to sort out who’s where.”
There’s quite a bit of overlap between the Walker and Rubio proposals. Both would use refundable tax credits to help people buy health coverage, set up state-based high-risk pools to cover Americans with pre-existing conditions and expand the use of health savings accounts. They also would reduce Medicaid spending: Rubio by providing block grants to states, and Walker by capping payments.
But Walker’s proposal lays out many more specifics for how the tax credits would work. They would be based on a person’s age, not income as the Affordable Care Act does, and they would be available only for those without employer-sponsored coverage.
The plan is much more detailed than what Mitt Romney presented in his 2012 race against President Obama. Romney was criticized at the time for remaining vague about how his proposed tax credits or deductions would work.
And while some Republicans in Congress, including Rep. Tom Price, have released Obamacare replacement plans, the leadership has never backed any one plan, instead holding multiple votes on ditching parts or all of the healthcare law.
Their reticence to take a particular stand may have made sense from a political point of view, giving less room for Democratic attacks. And the healthcare law remains unpopular among GOP voters, meaning Republicans can gain a lot of capital by simply criticizing it.
“Candidates should show enough leg to show that they have a serious plan, but not enough to tie their hands or get them in trouble,” said Tevi Troy, president of the American Health Policy Institute and a former adviser to Mitt Romney.
Jindal, who released a 26-page proposal in February, for months was the only Republican with an extensive plan. He said in the spring that “anyone thinking of running for president” should offer a detailed plan to replace the healthcare law.
When Walker did so, Jindal was quick to slam it, calling it “Obamacare-lite.” “It is frankly shocking that a Republican candidate for president would author a cradle-to-grave plan like this,” Jindal said.
“Gov. Walker has taken the bait laid out for him by the president, and has accepted the notion that we need a new federal government entitlement program, and now he is merely quibbling over the details,” he said. “So here we are again, not standing on free-market principles, but rather, establishing ourselves as ‘cheaper Democrats.'”
Troy said he expects more Republicans to release their own health reform plans. A spokesman for Sen. Ted Cruz said “of course” when asked whether his boss would present more detailed ideas at some point. A spokesman for Jeb Bush also said the campaign plans to release a more detailed plan at some point.
The campaigns of Donald Trump and Ben Carson — who along with Bush are leading Walker, Rubio and Cruz in the polls — didn’t respond to questions about whether they would release health reform proposals.
“I think it is likely, nay certain, that we will see more GOP candidates come out with their own health care proposals,” Troy said. “Healthcare is now a key issue on the Republican side of the aisle, and candidates need to show where they stand on it.”
