The Republican Unicorn: The Replacement Plan

UnicornOH! the horror… more Nevadans are now getting health care insurance thanks to the Affordable Care Act.  The Reno Gazette Journal reports:

“Nevada Medicaid enrollments under federal health care reform have surpassed initial projections and are on pace to reach 500,000 by summer, a mark initially not expected to be reached until the end of the 2015 fiscal year, a state official said.”

Prior to the enactment of the Affordable Care Act there were approximately 642,000 Nevadans without health insurance.  The expansion of Medicaid allows those who are earning  below 138% of federal policy guidelines to sign up for Medicaid.

For two person family the members of which are U.S. citizens between the ages of 19 and 65, who are not eligible for Medicare, the income line would be $21,404 per year, the income eligibility level for a single individual would be $15,856. [ME2014 pdf] A person working for $7.50/hr for a 50 week year would earn $15,000.

Since this is an election year, the Republicans will no doubt tell us all that they have an alternative, and indeed they did craft one earlier this year.

A side by side comparison of the Affordable Care Act and the Republican alternative:

ACA and GOP health plansIn the Republican “alternative du jour” people who don’t get health care insurance from their employers would end up paying more because in the GOP proposal the tax credit increases only by age and not by need.  This means that lower income individuals would be paying more for health care insurance.  [See example here]

Would those who have endured some of the questionable practices of insurance administration be protected under the Republican alternative?  Not really.  Under the Affordable Care Act an insurance corporation may only charge a 64 year old person 3 times what they would charge a 21 year old. Under the provisions of the Republican alternative they could charge 5 times more.

Then there’s the issue of a “coverage gap.”  If a person were to lose a job the compensation for which included health care insurance, the subsequent “gap” in coverage would allow the corporation to exclude the person from coverage because of a pre-existing medical condition if the individual did not purchase a private plan immediately.

In sum, the Republican alternative isn’t really “patient centered” a better term might be insurance corporation centered:

“There are many other problematic things the Republican plan does, like eliminate the health law’s taxes on health insurance, drug and device companies; allow insurance companies to sell plans that don’t cover maternity, mental health or other types of care; and allow insurance companies to impose annual limits on benefits.” [NYT]

Before we get too excited about the Republicans actually offering up an alternative to the Affordable Care Act and Patients’ Bill of Rights, we should remember that 2014 is an election year.  A person could waste precious moments in this life counting the number of Republican “working groups” which have developed GOP health insurance reform plans.  However, that exercise would expend synaptic effort unnecessarily because the GOP has yet to form any viable legislative strategy for enacting their ‘reforms.’

Harken back to January 30, 2014 — House Majority Leader Eric Cantor (R-VA) announced to the GOP conclave that “This year, we will rally around an alternative to ObamaCare and pass it on the floor of the House,” Cantor said during a presentation in which he outlined four areas — healthcare, jobs, helping the middle class and creating opportunities — where Republicans would offer “big, bold ideas.” [The Hill]   Now, hold this thought, because something happened to those “big, bold ideas” between January and March.

No sooner did the House Majority Leader pronounce, “This year, we will rally around an alternative to Obamacare and pass it on the floor of the House..” then the silent fog of actual inactivity enveloped the House Republicans.  By February 21, 2014 those big, bold ideas apparently disintegrated into a host of piece-meal bits of proposed legislation: “In a memo to members laying out the House agenda for the remainder of the winter, Cantor noted that the replacement is being finalized, and said that in the meantime, Republicans will work to target parts of the law with which they disagree.” [Roll Call]  Repeal and Replace, appears to be getting fuzzier by the month, a point not lost on columnist Jonathan Chait:

“Carping from the sidelines is a great strategy for Republicans because status quo bias is extremely powerful. It lets them highlight the downside of every trade-off without owning any downside of their own. They can vaguely promise to solve any problem with the status quo ante without exposing themselves to the risk any real reform entails. Republicans can exploit the disruption of the transition to Obamacare unencumbered by the reality that their own plans are even more disruptive.”

Meanwhile, more people are finding affordable private health care plans on the state and national insurance exchanges and more lower income citizens are signing up for the expanded Medicaid program.  And, the calendar marches on:
House Calendar 2014

And so, what has the House been working on?  On January 9 and 10, 2014 the GOP toyed with some headline generating legislation (H.R. 2279) delaying the implementation of the ACA and calling for ‘transparency.’   On January 23rd they launched on the ‘security’ of the health care exchange. (H.R. 3362).  Then they were back to the Ban The Abortion theme in the consideration of H.R. 7 on January 28, 2014, as if the Hyde Amendment has somehow been misplaced.

Do we see all that legislation to Repeal and Replace so avidly promised in January and then all but forgotten by March?  The Health and Technology Committee didn’t even meet during the month. [docs.house]

The lovely thing about a Unicorn is that it can be any color which delights a person’s imagination.  The same can be said of the Republican alternative to the Affordable Care Act — it can contain just about anything the audience wants to hear, because “facts are still being gathered,” or “provisions are still being drafted,” or “committees are still giving it consideration,” or “the dog ate my homework.”

Until the Republicans unveil their comprehensive alternative to the Affordable Care Act the Repeal and Replace slogan is just that — sloganeering.  And until the Republicans can demonstrate their capacity to LEGISLATE (read govern) there is no reason to take their propositions seriously.  While we wait for the Republicans to chase their Unicorn, we can applaud the fact that more of our fellow citizens have health insurance coverage, and wonder what the Republican Party will be able to do for the next five years.

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Filed under Economy, Health Care, health insurance, Medicaid, Nevada politics, Politics

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