Replacing Obamacare not easy

Trying to repeal Obamacare has long been a popular (if futile) Republican pastime. Now replacing Obamacare is catching on, at least among Republican presidential candidates. This would count as progress, except that none of their proposals quite meets the definition of “replacement.”

The whole point of health care reform is, or should be, relatively straightforward: providing the best possible health insurance to the largest possible number of people at the lowest possible cost. How do the candidates’ various proposals fare under these criteria?

Under Wisconsin Gov. Scott Walker’s plan, 6 million more people reportedly would have private health insurance than under Obamacare. How many would lose government-sponsored coverage, however, is left for voters to guess. Sen. Marco Rubio’s outline doesn’t mention the effect on insurance levels at all. But it’s unclear how any plan that rolls back the expansion of Medicaid, as both plans do, could insure as many people as Obamacare does through other means.

It also seems likely that the quality of that insurance, measured in the breadth of services covered and the share of costs borne by beneficiaries, would be lower, considering that Rubio and Walker would lift Obamacare’s provisions for essential benefits.

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As for the other candidates, Louisiana Gov. Bobby Jindal has a plan that includes replacing the tax exclusion for employer-sponsored plans with a standard tax deduction, but that is unlikely to maintain Obamacare levels of coverage. Ohio Gov. John Kasich says everyone should have health insurance, and he supports the expansion of Medicaid, but he says he doesn’t like mandates. Donald Trump says he would replace Obamacare with “something terrific,” and it would involve hospitals.

The Congressional Budget Office has repeatedly said that repealing Obamacare would add to the deficit, because the law’s tax increases and cuts in Medicare raise or save more money than its new benefits cost. So to qualify as an improvement, any alternative proposal needs to reduce the deficit more than Obamacare does (about $137 billion over 10 years), while still covering the same number of people.

There’s nothing precious about Obamacare. It’s shortcomings are significant.

But replacing Obamacare with something that accomplishes less would not be progress. •

Bloomberg View editorial.

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1 COMMENT

  1. Why not let each state set up their own healthcare plan. Governor Romney developed a state controlled healthcare plan that is still being used in Massachusetts and coveredd 98% of the residents of Massachusetts. If Romney could do it, so could all the other governors of each state in the United States.