One of the most consistent raps against Republicans over their four years of fevered anti-Obamacare advocacy is that for all the symbolic efforts they've undertaken to repeal the law, they haven't been able to muster a consensus over how to replace it.
It's the one thing about the party's Affordable Care Act campaign that the traditional media feels comfortable criticizing Republicans for, and something like a running joke in national politics.
Well, now that millions of previously uninsured people are actually covered and getting lifesaving, non-bankrupting healthcare, the repeal-but-no-replace position has finally become unstable enough that House Speaker John Boehner is publicly predicting that Republicans will unveil an official alternative in the next few weeks.
"Republican House members will be having our retreat about a week and a half from now," Boehner told reporters last week at his regular Capitol briefing. "It's one of the big issues for conversation in terms of our agenda for this year. And I think you'll see Republicans come forward with a plan to replace Obamacare. A plan that will actually reduce costs for the American people and make health care more accessible."
The surprise here is that Republican leaders might actually put forward a healthcare reform bill of any kind at all. Individual Republicans have proposed healthcare bills designed to replace Obamacare over the years, but none has won the endorsement of skittish party leaders.
What I don't think will come as any surprise is the (likely) content.
For years now, Republicans have filled the void left by the absence of a replace plan with focus-grouped descriptions of the healthcare ideas they like. These will be familiar to anyone who's followed the story closely: repeal Obamacare, allow for the sale of insurance across state lines, bolster high-risk pools for people with preexisting medical conditions, equalize the tax treatment of individual and group insurance, block-grant Medicaid and cut its funding, tort reform.
Most of these are bad ideas, and the two that aren't bad ideas per se are bad ideas in the context of the rest of the reforms. High risk pools could be a defensible alternative to Obamacare's insurance guarantee, but only if adequately funded, and Republicans have no intention of spending hundreds of billions of dollars to do that.
Likewise, equalizing the tax treatment of individual and group health insurance is a great idea in the proper context, and something Obamacare will begin to do a couple years from now. But it's a terrible idea to do it too rapidly, and without creating an alternative system for people in group plans who will lose their insurance as a result -- particularly those with preexisting conditions who would be relegated to the underfunded high-risk pools!
If House Republicans introduce a healthcare bill -- still a big if! -- I'm pretty confident it will be built around these old ideas. A few conservative policy experts have described other approaches that would at least preserve universality, but House Republicans just aren't as far along in their journey through the stages of Obamacare grief as movement intellectuals are. I'd be genuinely surprised if more than a handful of Republicans support a universal coverage plan, let alone enough for Boehner to feel confident offering such a plan as the official Republican alternative.
And in the unlikely event that Republicans decide to keep elements of Obamacare and build conservative reforms into them, it's likely that they will be plans designed to devolve Obamacare back toward the conservative ideal.
The genuinely interesting question is, What will Republicans propose to do about the X million people who will be newly insured by the end of March. They dedicated the entire final quarter of calendar year 2013 to effusing sympathy for people whose insurance policies were canceled because of Obamacare. It would be incredibly conspicuous for them to introduce legislation that would then kick millions more people off of their plans, particularly given the unlikelihood that they intend to create a similarly generous parallel system. But the only way to avoid that would be to include a grandfathering provision. If you like your Obamacare you can keep your Obamacare. Even if conservatives would agree to preserve something as monstrous as Obamacare, they know better than to make that promise.
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