The GOP’s Ultimate Health Care Plan B

Because Republicans have spent so much time trying to erase their fingerprints on the blueprints for the Affordable Care Act, and pretending it’s “socialized medicine,” they haven’t done much thinking (in public, at least) about how to exploit the president’s huge concession of choosing a heavily private-insurance based model for quasi-universal coverage.

That changed with the Reuters column by Douglas Holtz-Eakin and Avik Roy today on “The future of free-market healthcare.” It’s a relatively straightforward analysis of how Obamacare’s health exchanges and subsidies can be used to undermine and eventually replace public health insurance programs:

[W]e should use the insurance exchanges in the service of Medicare reform. Instead of bothering with complex legislation, Congress should raise the eligibility age for traditional Medicare by three months each year — for the foreseeable future. Retirees will then gradually migrate into the exchanges’ premium-support systems.

Medicaid-eligible seniors should also be offered exchange-based coverage, to improve the quality and coordination of their care.

Fourth is to gradually shift the remainder of Medicaid’s low-income enrollees into the exchanges. Today, Medicaid recipients face a strong disincentive to seek work, because entry-level jobs can force them to give up their health coverage in exchange for modestly higher income. The exchanges would allow these workers to climb up the income ladder while maintaining their insurance.

The end result would be a fiscally sustainable, fully reformed set of entitlement and insurance programs that place American families in charge of their own health dollars. In other words, everything that conservatives have always wanted. And we’d have Obama, in part, to thank.

We’re going to hear a lot more of this sort of talk if conservatives decide they can’t sabotage Obamacare’s implementation or reverse its key provisions. Granted, earlier in the column the authors talk about eroding the insurance regulations that made Obamacare a coverage expansion in the first place, and significantly reducing the scope of its subsidies. Perhaps the best way to describe this strategy is as one that sells itself as a reform of the post-ACA health care system instead of a restoration of the pre-ACA status quo ante. But get used to it.

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Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.