If the reigning Democratic dilemma on health care reform is how to expand coverage without upsetting people happy with the status quo (a challenge not being handled extremely well at the moment), the parallel GOP challenge is how to express solidarity with people happy with the status quo while embracing policies that would shrink coverage in the name of cost-efficiency.
I wrote about the GOP’s little problem in May of 2012, when I felt Republicans were getting away with disguising their long-range health care policies:
Best anyone can tell, the only post-ObamaCare actions we can count on Republicans to take involve the Ryan Budget’s attacks on Medicare and Medicaid, plus that “market-based vision” which essentially means pushing the whole country into the individual health insurance market and then encouraging insurance companies to discriminate to their heart’s content by allowing them to circumvent state regulation via interstate sales. From the point of view of the uninsured, and those paying exorbitant premiums for crappy coverage because they are sick, this “vision” is a reversal, not just a “repeal,” of the progress made under ObamaCare. Between the green light they want to give insurers to discriminate, the discouragement of group coverage through elimination of the employer tax subsidy, and the vast restriction of Medicaid eligibility the Ryan budget would force, we could be looking at a significant increase in the ranks of the uninsured. I don’t expect Republicans to brag about all that, but the truth is repealing ObamaCare is the least of the damage they are promising to inflict.
This was before Paul Ryan got up in front of the Republican National Convention and pretended to be the staunchest champion of Medicare you’d ever see.
Now Republicans are at it again, wailing and gnashing their teeth on behalf of the people whose crappy individual health insurance policies are getting croaked by Obamacare regulations. TNR’s Jonathan Cohn reminds us again that the people doing all this sympathizing with the status quo have pretty radical plans to mess it up a whole lot more than anything in the Affordable Care Act:
It’s good politics, I’m sure. It’s also breathtakingly cynical. Republicans have repeatedly endorsed proposals that would take insurance away from many more Americans—and leave them much, much worse off.
Start with the federal budgets crafted by Paul Ryan. You remember those, right? Those proposals passed through the House with unanimous Republican support and were, in 2012, a basis of the Republican presidential platform. Those budgets called for dramatic funding cuts to Medicaid. If Republicans had swept into power and enacted such changes, according to projections prepared by Urban Institute scholars and published by the Kaiser Family Foundation, between 14 and 20 million Medicaid recipients would lose their insurance. And that doesn’t even include the people who are starting to get Medicaid coverage through Obamacare’s expansions of the program. That’s another 10 to 17 million people.
And it’s not just people on Medicaid who would lose coverage if Republicans got their way. While Republicans in Congress have not unified by a single alternative to Obamacare, a building block of virtually every proposal in circulation is to equalize the tax treatment of employer-sponsored insurance and individual insurance—which, in layman’s terms, means making it much more appealing for somebody who gets coverage on the job to buy coverage on his or her own. Typically these proposals would allow insurers selling individual coverage to continue some of their current practices, like charging higher premiums or refusing to cover certain services for people with pre-existing conditions, or offering coverage with serous gaps in benefits. Most experts believe such reforms would hike the cost of employer plans, as only sicker people remained on them, potentially creating a “death spiral” that would lead to fewer employers offering plans….
More important, though, look at the kind of change taking place. Almost everybody giving up a non-group policy today has the option to get new insurance either through Medicaid or one of the new Obamacare marketplaces. Some people will pay more for these policies, some will pay less, but everybody will be getting coverage that includes an array of “essential” benefits, limits out-of-pocket spending, and can never be taken away or limited because the policyholder gets sick. In other words, everybody ends up with comprehensive, stable insurance. It may not be the policy he or she has today. But the vast majority of people with non-group market don’t keep the same policy for more than two years anyway.
Under the Republican plan, by contrast, people losing employer insurance would end up in the dysfunctional, non-reformed individual market—the one full of confusing, junk policies that might not cover basic services like maternity or mental health or have huge gaps in coverage. And the people losing Medicaid? They would end up with … nothing at all.
So people who just love the health care status quo ante have a lot more to fear from the GOP than from Obamacare. But it’s ridiculous we’re even looking at the issue that way. Whether or not this or that group of individuals is happy with his or her coverage, the whole pre-Obamacare system adds up to the world’s most grossly expensive and at the same time inadequate non-system. That’s why we were talking about health care reform in both parties before the enactment of the Affordable Care Act.