Repeal and replace with … nothing

Updated
 
Giving up on creating a health care plan makes Mitch McConnell smile.
Giving up on creating a health care plan makes Mitch McConnell smile.
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Even before the Affordable Care Act was signed into law two years ago, congressional Republicans adopted a simple, three-word, poll-tested phrase: “repeal and replace.” The GOP would repeal the moderate reform law, which is based on a model Republicans used to support, and replace it with something new.

Shortly after the 2010 midterms, Republicans still paid some lip service to the idea, but 15 months after taking the House majority, the GOP plan to reform the nation’s health care system – the “replace” part of the equation – doesn’t exist. There have been no plans circulated, no hearings scheduled, nothing. It’s almost as if Republicans weren’t sincere about following through on their promises to reform the old, dysfunctional health care system.

Maybe in 2013 we’ll see GOP lawmakers follow through? Senate Minority Leader Mitch McConnell (R-Ky.) suggested to Ramesh Ponnuru that the Republican plan has changed a bit – and only the first of the three words still matters.

If the court keeps the law and McConnell becomes Senate majority leader, he vows that “the first item up would be to try to repeal Obamacare.”

But he doesn’t favor comprehensive legislation to replace it. “We would want to more modestly approach this with more incremental fixes,” he told me. “Not a massive Republican alternative.”

Two ideas McConnell mentions are allowing people to purchase health insurance across state lines and reforming medical-malpractice laws.

As Jon Chait explained, “The choice we face is not between Obamacare and some different, even more ‘market-friendly’ alternative reform. It’s between Obamacare and subjecting millions of Americans to the insecurity and suffering of lacking health insurance. The uninsured can have the Republicans’ answer now. Their offer is this: nothing.”

When the debate over health care reform got underway in earnest in 2009, Frank Luntz and other GOP pollsters/strategists warned the party that Americans expected improvements to the dysfunctional system, and Republicans couldn’t simply say “no” to everything.

Three years later, that’s effectively where the party has ended up: wanting to go back to the mess “Obamacare” is cleaning up.

But what about McConnell’s main idea? It’s one of the GOP’s favorite talking points: we don’t need real reform; we just need to let consumers buy across state lines. President Obama and the Affordable Care Act allow this, but set minimum standards that states must abide by. McConnell and his party want to go further, removing, or at least severely weakening, those standards.

This is generally called the “race to the bottom.” Under McConnell’s vision, state policymakers would tell insurers that if they were to set up shop in their state the rules would be written in the industry’s favor. The industry would go with the state that offered the sweetest deal – which is to say, the most lax oversight with the fewest restrictions – and before long, it would be consumers’ only choice. Why? Because every insurer would move to that state, leaving Americans with no other coverage to buy.

That’s exactly what happened with the credit card industry, and it’s a model to be avoided, not followed.

So what’s wrong with Obama’s approach of minimum standards to prevent this? For consumers and families, nothing. For conservatives, though, it means federal regulations, and we can’t have that because it would mean officials looking out for consumers, which is, you know, bad. Or something.

It gets worse. The Congressional Budget Office did an analysis of the idea in 2005, when there was a Republican Congress and Republican White House.

The legislation “would reduce the price of individual health insurance coverage for people expected to have relatively low health care costs, while increasing the price of coverage for those expected to have relatively high health care costs,” CBO said. “Therefore, CBO expects that there would be an increase in the number of relatively healthy individuals, and a decrease in the number of individuals expected to have relatively high cost, who buy individual coverage.”

That is to say, the legislation would not change the number of insured Americans or save much money, but it would make insurance more expensive for the sick and cheaper for the healthy, and lead to more healthy people with insurance and fewer sick people with insurance. It’s a great proposal if you don’t ever plan to be sick, and if you don’t mind finding out that your insurer doesn’t cover your illness.

If and when the debate returns to Congress, keep this in mind.

Mitch McConnell

Repeal and replace with ... nothing

Updated