It has never been a secret that congressional Republicans resoundingly disdain the Affordable Care Act. After all, the U.S. House of Representatives has voted 46 times to repeal the measure, which passed along party lines in 2009 and was likely the largest factor in the “shellacking” that turned the House over to Republicans in 2010. What has been missing in the chorus of opposition to Obamacare, though, is an alternative proposal. Republicans are crafting one to offer with their renewed push for repeal. It does not pass muster.
The proposal, dubbed the Patient Choice, Affordability, Responsibility and Empowerment Act, was crafted by Sens. Orrin Hatch, Tom Coburn and Richard Burr, of Utah, Oklahoma and North Carolina, respectively. It would repeal the Affordable Care Act and replace it with a program that would keep two of its key provisions – that dependents can remain on their parents’ plans until age 26, and that insurance companies cannot impose lifetime coverage limits on policy holders – while doing away with some of the more important aspects of the law. It would rework the guarantee of coverage regardless pre-existing conditions by offering the guarantee only to those who have had insurance all along – but not extending it to those who currently lack coverage. That alone makes the proposal an irresponsible alternative to Obamacare, which, for all its flaws, has made insurance coverage accessible to many who previously could not find it or afford it.
The senators’ proposal would also lift the requirement that individuals obtain insurance coverage and that medium and large businesses provide it for their employees. By doing so, fundamental assumption of the Affordable Care Act – extending coverage to virtually all Americans will help bring down health care costs, both institutionally and individually – is undermined.
Repealing these two provisions would set health care reform back to its pre-Obamacare status, while offering little meaningful justification for doing so. There are no concrete cost estimates as to what the proposal would entail, other than it is intended to be “roughly budget neutral” over 10 years, according to the senators. To keep costs down, the measure would maintain Obamacare’s cuts to Medicare reimbursement – a problematic notion already – and would limit employers’ ability to claim an unlimited tax exclusion for the plans they provide their workers.
If controlling costs – for patients, insurers, employees and the federal government – is the goal, it is unclear how this proposal reaches it.
Instead, lawmakers of all stripes would make better use of their energy by fine-tuning the Affordable Care Act to account for its shortcomings and follow up with measures that can what the measure did not address – namely the overarching cost components. Starting from scratch by eliminating the elements that, however inadequately, do get at the cost of health care, is negative progress. Congress should turn to the policy issues that are languishing under the obsession with dismantling Obamacare. Forty-six votes to repeal is more than enough of a statement. It is time to move on.
