Repealable But Not Replaceable

One of the positive byproducts of the looming threat that the Supreme Court will declare the Affordable Care Act (or key elements of it) unconstitutional is that more attention is gradually being paid to what, exactly, ObamaCare’s Republican critics would do to deal with the cost, access and quality issues it was designed to address.

There’s a solid new LA Times article by Noam Levey that provides a good refresher course on Mitt Romney’s latest health care proposals, which are sort of an amalgam of what George W. Bush and John McCain proposed a few years back, along with the Ryan Budget’s treatment of Medicare and Medicaid.

But TNR’s Jonathan Cohn has the best succinct description of how it all adds up:

Estimates of House Budget Chairman Paul Ryan’s proposal, which Romney has embraced and which would likely be similar to his approach, have suggested that the cuts to Medicaid alone could take health insurance away from between 14 and 27 million people. That’s not including those who would lose out on coverage they stand to get, right now, from the Affordable Care Act.

Not that Republicans seem to care much. They like to say their focus is on “cost” as opposed to “coverage.” I’m sure it’s an effective line politically: It suggests that Republicans are focused on the deserving insured, while Democrats are spending their time (and your money) on the less deserving uninsured.

But that claim highly misleading. Under the Republican proposals, insurance would become cheaper mostly because it would cover less and would be available to fewer people who need it. Conservatives believe their system would encourage competition, but, more likely, it would encourage the kind of competition we have already: A competition among insurers to insure the least risky beneficiaries, rather than a competition to provide more efficient care to people who actually need medical care.

So the “Replace” in the GOP “Repeal and Replace” agenda for health reform is a complete fraud in the sense that it does not even attempt to address the challenge of achieving universal access to affordable health care. The last large-scale effort by a Republican politician to do that was in Massachusetts, and it depended strictly on a federal commitment to Medicaid that its author now wants to scrap, along with a national version of his own handiwork. “Repeal and Ignore” would be a more accurate slogan.

Ed Kilgore

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.