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A New Republican Health Care “Plan”

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Not satisfied with the “Republican plan” that was enacted into law with no ex ante, contemporaneous, or ex post facto support from any national Republican, some congressional Republicans are pretending to have an alternative to the ACA. Its most salient issues:

  • The end of guaranteed issue.  You do have some pre-existing coverage protection if you’ve been lucky enough to have been continuously insured for 18 months and would never miss a deadline.
  • The regulations requiring that insurance actually provide things are eliminated, as are the regulations requiring more equitable premiums among age groups.
  • The subsidies are much less generous.
  • Tort reform, and plenty of it!
  • Perhaps most importantly, the Medicaid expansion would mostly be eliminated — only a small subset of the working poor would be included rather than everyone within 138% of the federal poverty line.  As Avik Roy enthuses, “Under the per-capita cap approach, the federal government would give states a fixed amount of money per person enrolled in Medicaid. It would be up to the states to use that money in the most cost-efficient way possible.”  Oh, goody — if the aftermath of the ACA has shown us anything, it’s the strong commitment of red states to provide health care to the poor.

Like the actual rather than the imaginary Heritage Plan although configured slightly differently since Republicans discovered that a tax penalty for not carrying insurance was the greatest threat to human liberty ever, this is what Republican health care reform would look like if Republicans actually supported health care reform.   That is, 1)horrible and 2)radically different from the ACA.  Admittedly, if you’re the kind of progressive for whom it’s better that millions of people go uninsured than anyone make a low-margin profit insuring them, you might like this proposal — private insurers will certainly have fewer customers.  Which will surely cause them all to vanish soon, because…look, it’s the people with the most influence on the contemporary Republican Party, John Paul Stevens and Zombie John Chafee!

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