Senate Majority Whip John Cornyn (R-Texas), reviving an old, awful argument, said over the weekend that the Republican health care plan must be better than the Affordable Care Act – because it has far fewer pages. Politico’s Blake Hounshell noted in response, “It’s short because it leaves the basic structure of Obamacare in place.”
This may seem counter-intuitive, but it’s important to understand why Hounshell’s response is accurate.
I’ve heard from a few readers who’ve expressed confusion about the competing messages. Opponents of the Republican plan from the left condemn it as a needlessly vicious monstrosity that will hurt millions. Critics of the plan from the right dismiss it as “Obamacare Lite.” Clearly, they can’t both be right.
Or can they?
The answer has to do with the structure of the system in the broadest possible sense. Imagine looking at the models from 20,000 feet, where relevant details are harder to see. The core of the ACA model is a system that provides tax credits to consumers to purchase health insurance. At the core of the Republican alternative is a system that provides tax credits to consumers to purchase health insurance.
The profound differences matter, obviously, and in many cases, would quite literally be a matter of life or death. But when you hear someone like Rand Paul or Mike Lee say the bill reminds them too much of the Affordable Care Act, the comments aren’t entirely ridiculous. Their perspective is incomplete in a way that paints a misleading picture, but they’re saying they prefer an entirely different model – as opposed to an ungenerous version of the status quo.
Indeed, the Senate Republicans’ bill maintains the ACA’s model even more than the House bill, since it relies on income-based tax credits – as opposed to age-based tax credits – just as “Obamacare” does.
Just so we’re absolutely clear, I’m not suggesting that ACA advocates should somehow see the Senate Republicans’ bill as tolerable. In fact, the opposite is true: the GOP bill would have a genuinely devastating impact on millions of families. The effects on the poor would be especially brutal, but the Republicans’ legislation would also hurt the disabled, seniors, hospitals, anyone who takes advantage of consumer protections such as the ACA’s ban on annual and lifetime limits, and many others.
The GOP plan would represent one of the cruelest assaults on a health care system, not only in American history, but in any Western democracy in modern times. I’ve yet to hear a coherent argument as to why this plan should be taken seriously, much less passed into law.
My point, however, is to explain why some conservatives have criticized the bill from the right. They see some vague similarities between the broad outlines of Mitch McConnell’s model and the ACA model, and for some conservatives, that’s a problem.