… falls short of market-based health reform.
Republicans have long been in agreement about the need to repeal the Affordable Care Act, and replace it with a health-care reform package that employs free market methods to reduce costs and increase coverage. This is an admirable and indeed critical goal. But in the rush to avoid being portrayed as “the party of no,” it is important to recognize that there is a right way to replace Obamacare, and a wrong way. The proposal authored by Senators Tom Coburn (R-Oklahoma), Richard Burr (R-North Carolina), and Orrin Hatch (R-Utah), and released as the Patient Choice, Affordability, Responsibility, and Empowerment Act (CARE) is a definitive example of the wrong way.
The Coburn-Burr-Hatch plan (CBH) does have a handful of positive characteristics. Title I of the proposal repeals the most onerous parts of Obamacare, including the much-reviled individual mandate, and for this it should be commended. As a whole, however, it retains far too much of the framework that makes Obamacare such a regulatory disaster.
To begin with, the plan restores many of the same administrative burdens that Obamacare imposes on private insurance companies. It still requires that insurers allow young adults to remain on their parents’ plans until age 26, and it introduces a slew of disclosure regulations that increase administrative costs for insurers. Additionally, while the overt requirement to accept patients with preexisting conditions is not included, insurers would be forced to take patients with such conditions who have been continuously covered by insurance for at least the past 18 months. That’s merely doing the wrong thing in a less wrong way.
The Affordable Care Act prohibited insurance companies from charging older patients more than three times the rate offered to younger ones. While the authors of CBH acknowledge that such a requirement is restrictive and forces costs up for young people, their plan would retain the regulation, merely substituting a ratio of five to one for Obamacare’s three to one. This is a change of degree, not of principle, and the wrong approach to establishing a free market for healthcare.
While these regulatory burdens would likely pose little challenge to large, well-established insurance companies, the barriers to entry they create would discourage new and smaller firms from joining the market, ultimately harming competition, limiting consumer choices and keeping prices high. This is the wrong approach. We should be promoting competition, not restricting it.
The CBH plan further complicates the already bloated and distorted tax code by instituting a series of means-tested, age-based tax credits to individuals earning up to three times the federal poverty threshold, while at the same time capping the tax-free deductibility of health-care expenditures at 65 percent. This is effectively a large tax increase on workers who have access to employer-provided health insurance, and the phase out of the tax credits raises the implicit marginal tax rates on middle-income families.
Increasing taxes on the one hand while offering tax credits on the other is a redistributionist policy, far from the free market reforms the proposal’s authors’ claim. The means testing and age-based nature of these credits fails to end the current discrimination against the purchase of health insurance by individuals in the same way that a flat, lump sum credit that treats all Americans equally would.
All this is not to say that there is no conservative alternative to Obamacare. In fact, there have been several proposals that do a better job of reforming the health-care system in a way that fosters competition — leading to reduced costs as well as increased quality of service.
To point to one example, the Patient OPTION Act authored by Representative Paul Broun (R-Georgia) takes a number of important steps in the right direction. For example, it allows consumers to purchase insurance policies across state lines, eliminating a major barrier to competition. *
Additionally, Broun’s bill tackles the much needed reform of Medicare and Medicaid, making Medicare benefits voluntary for seniors, who deserve the right to opt out of a government program that they may not want or need. The bill further provides 100 percent deductibility on all health-care expenses, including health insurance by individuals, purchasing coverage independently of their employers.
Broun’s plan is not the only one out there that offers a real conservative alternative to the Affordable Care Act, and there is no shortage of ideas regarding a true market-based approach to health-care reform. Embracing a bad policy with the mindset that any plan is better than no plan is what got us into this mess to begin with, and Republicans would be wise not to repeat the Democrats’ mistakes in this regard. It is vital that we repeal Obamacare and replace it, not just with any plan, but with the right plan. What is clear is that CBH is wrong not only for Republicans, but for America.
* While Broun’s across-state-lines provision is admirable in its goal, it unfortunately uses the wrong tool: federal legislation, purportedly based on the Commerce Clause. In fact, such legislation is neither constitutional nor prudent. It will lead to more federal meddling, not less. Across-state-lines should be pursued at the state level through voluntary interstate compacts.