The Latest Little-of-Everything GOP Health Proposal

I don’t know if they think by endlessly tweaking conservative health care concepts they will eventually land on something that most Republicans and something within shouting distance of a majority of the public will accept, but a sorta-new proposal outline for an Obamacare “alternative” has now been unveiled by Sens. Hatch and Burr and Rep. Fred Upton. As described by the New York Times‘ Robert Pear, it includes a lot of features that conservatives keep going back to: devolution of responsibility for Medicaid to the states with a sort of “block grant;” partial exposure of employer-based insurance to federal tax liability; a shift from exchange-based purchasing subsidies to a smaller and less available federal tax credit; and a return to state-based insurance regulation.

A couple of new wrinkles track the general theme of dumping decisions on the states. States could keep or discard the Obamacare provision allowing children to stay on their parents’ policies until the age of 26. They could also decide to let insurers discriminate more or less against old folks than a national standard of a five-to-one ratio as compared to young people (under Obamacare it is three-to-one with no state power to vary it). One thing that’s not clear from Pear’s account is whether the conservative pet rock of interstate insurance sales–which makes a mockery of state power over insurance regulation–is in the proposal.

All in all, the proposal looks a lot like a less attractive and workable version of the ACA–but with all the mandates repealed–so I doubt it will attract any sort of Republican consensus. But they’ll keep beavering away at it until it’s all moot.

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.