Home / General / The Heritage Plan *Was* the Conservative Alternative to the ACA. It Was Much Worse Than the AHCA.

The Heritage Plan *Was* the Conservative Alternative to the ACA. It Was Much Worse Than the AHCA.



Not this again:

Ah, yes, “durr, Obamacare was the Heritage Foundation plan, durr” — the go-to for anyone who doesn’t know what they’re talking about and for whatever reason wants to imagine American conservatism as being much better and/or American liberalism as being much worse than they are. Anyway, this is an absolutely absurd characterization. To summarize, the Heritage Plan was to end Medicare and replace it with a voucher system, end Medicaid and phase out employer-based insurance, and require everyone not eligible to Medicare to purchase largely de-regulated catastrophic insurance with ungenerous subsidies.  It is, in other words, radically different than the ACA. Saying the ACA is “based on” the Heritage Plan is like saying George W. Bush’s plan to privitize Social Security was “based on” FDR’s Social Security legislation. The only thing they have in common is the requirement to carry insurance, a banal recognition that insurance requires a broad pool to work that was hardly invented at Heritage.

As you know, at this point people strongly committed to the utterly false claim that the ACA was the “Republican plan” invented by the Heritage Foundation will generally add the second and third cards to the 3-card monte.  First you compare the ACA to the decoy plan introduced by a senator from Rhode Island who favored a national handgun ban in 1993. The obvious problems with this comparison are that 1)the plans aren’t that similar (no Medicaid expansion) and 2)you have to be the most gullible rube in the world to the think federal Republicans have ever favored anything like the Chafee plan and would ever enact anything like it.  The typical next move is to compare the ACA to the plan enacted by veto-proof majorities of Massachusetts Democrats, which has the advantage of being a reasonable policy comparison but the fatal disadvantage of being completely irrelevant to national Republican health care policy preferences. (If only the Republican governor who signed the legislation after multiple overridden vetoes had been the Republican candidate for president so we could have seen if he would maintain support for this health care policy as a national Republican!)

Another variant of this argument is to say that Trumpcare failed because Obamacare was the Republican/conservative alternative for universal coverage. But this is also completely false. The Heritage Plan is the conservative alternative to the ACA.  If you combine Paul Ryan’s Medicare and Medicaid proposals with Trumpcare as amended by the Freedom Caucus, that’s basically the Heritage Plan with a clumsier and less effective mandate.  Here’s a handy guide for people who are for whatever reason delusional about the actually existing American political spectrum:

  • The conservative alternative to the ACA is to privatize Medicare while increasing the eligibility age, while ending Medicaid and employer-based insurance and replacing them with a de-regulated private market much less generously subsidized than the ACA.
  • The center-right alternative is to accept the political reality of mostly preserving Medicare while block granting Medicaid and gutting the private insurance market.
  • The Affordable Care Act, a plan to substantially expand Medicaid while increasing public expenditures and regulation on the private market is a compromise between the left and moderate wings of the Democratic Party that Republicans have always vociferously opposed.

Trumpcare didn’t fail because the ACA was the “conservative alternative.” It failed because only a politically suicidal party would enact any conservative alternative to the ACA. The ACA survived because it’s much harder to take away benefits tan it is to stop them from going into effect — but Republicans would always have done the latter if the had the power to do so. It’s really not complicated. And pretending otherwise is both false and politically worse-than-useless.




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