What would health reform look like if the Republicans get the chance to rewrite Obamacare?
It could end up looking a lot like Obamacare.
Republicans would have the chance to pass a plan of their own if the Supreme Court strikes down all or some of the current law or if they gain control of Congress and the White House in the next election. Under either scenario, prominent Republicans believe the party will have to come up with something.
Almost certainly, Republicans would drop the mandate that all individuals have health insurance. That has been their strongest and most consistent objection to the law. But what other changes would they make?
As outlined in a recent story in Politico, there is no way to tell. Current proposals put forth by Republicans in Congress run the gamut from doing almost nothing to creating a system that looks surprisingly like Obama’s.
Here are key elements some of the leading Republican plans in order of increasing complexity:
Rep. Paul Broun (D-Ga.), a physician, has a plan that follows some familiar party themes. He would encourage the use of health savings accounts, privatize Medicare, and let consumers buy insurance across state lines.
Rep. Tom Price (D-Ga.), an orthopedic surgeon, would offer tax credits to help cover the cost of insurance premiums and extend the tax deduction for employer-based coverage to individual plans. He would also cap some malpractice awards at $250,000.
Rep. Sean Duffy (R-Wis.) would implement limited insurance reforms, and guarantee young adults the right to remain on their parents’ coverage until age 23, rather than age 26 as under the Obama law.
Rep. Joe Heck (R-Nev.), an osteopathic physician, has plan that looks a lot like Obamacare. It would require insurance companies to accept all applicants without regard to health status but drop the mandate that everyone have coverage.
And guess who else supports a plan that’s remarkably similar to Obama’s? Rep. Paul Ryan (R-Wis.), the architect of the Republicans’ current budget proposal. He would create state insurance exchanges that guarantee coverage regardless of age or health status and offer subsidies to those with low incomes in the form of tax credits. Individuals who don’t sign up for a plan could be automatically enrolled in one when they seek care.
Ryan would even impose minimum coverage requirements for policies. They would have to contain the same standard benefits that members of Congress receive.
Should we be surprised that key Republicans would replace Obamacare with something very similar? Not at all. Obama took the basic outline of his plan, including the individual mandate, directly from them.
Mitt Romney implemented insurance reforms based on an individual mandate as governor of Massachusetts in 2006. The next year, conservative Senator Jim DeMint (R-S.C.) declared that the plan demonstrated Romney’s fitness to run for president.
And Romney based his plan on a proposal that was originally developed by the conservative Heritage Foundation in the early 1990s. Heritage stood behind it as late as 2007.
So, a health reform plan crafted by the Republicans could end up looking quite familiar. After all the rhetoric and partisanship, it could turn out to be Obamacare 2.0.
But with one possible exception. Republicans might not be able to include the individual mandate, as they had in previous proposals.
By the time they get their shot at health reform, they may have succeeded in having the Supreme Court declare it unconstitutional.
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