If anyone in the entire contemporary Republican Party seems capable of coming up with a credible health care plan to rival the Affordable Care Act, it's Louisiana Gov. Bobby Jindal (R). After all, the governor may be conservative, but he's also served as Secretary of Louisiana Health and Hospitals and as a top official in the Bush/Cheney Department of Health and Human Services. At Oxford, Jindal studied health policy and wrote his thesis
on a "needs-based approach to health care"
With this in mind, when the Louisiana Republican makes absurd comments about health care -- a problem that comes up
with alarming regularity
-- many assume it's just political palaver. Jindal knows what he's saying is wrong, but he makes these comments anyway for political reasons.
But it may be a mistake to simply give Jindal the benefit of the doubt and assume he has a genuine expertise. Yesterday, for example, we got a closer look at what "Bobbycare" might look like. Benjy Sarlin reported
Much of Jindal's plan is in line with previous conservative health care proposals: things like block granting Medicaid, turning Medicare into a voucher program in which seniors can purchase private plans, allowing insurance companies to sell plans across state lines, and limiting malpractice lawsuits. A more controversial element, though still familiar from a variety of GOP plans, is to slash tax breaks for employer health care plans and use the savings to provide a deduction for individuals to buy insurance. The standout, however, is that Jindal proposes committing substantial federal dollars to address Americans with pre-existing conditions, many of whom could not obtain affordable or reliable coverage under the old system. Under Obamacare, the costs of covering these consumers are spread out across the insurance market by mandating all Americans purchase insurance. Jindal does away with the federal mandate and proposes instead a $100 billion fund, separate from the Medicaid block grants, for state health care programs that can demonstrate they would lower premiums and cover patients regardless of their health status.
It's tough to apply too much scrutiny without a more detailed blueprint, but there are some pretty dramatic flaws with the vision Jindal presented yesterday.
One of the key goals of the Affordable Care Act was to cause as little disruption as possible -- it's why most Americans, who receive coverage through their employers, received important new consumer protections, but didn't see much else in the way of change.
Jindal would do the opposite, disrupting practically everything Americans know about the U.S. health care system by scrapping the tax subsidy for employer-based coverage. Igor Volsky flagged
a Center on Budget and Policy Priorities study
of this approach, which found that replacing the tax exclusion with a deduction "would likely cause employer-based health coverage to seriously erode by encouraging employers to discontinue their coverage."
As for the big twist -- Jindal's vision of a $100 billion high-risk pool -- this is intended to be the governor's idea for protecting those with pre-existing conditions, but Sahil Kapur highlighted
the plan's most notable drawbacks.
First, as conservative health policy experts James Capretta and Tom Miller estimate, high-risk pools aimed at covering up to 4 million people would cost between $150 to $200 billion over 10 years. So Jindal's figure is already low (although his policy director surmised that states could come up with the rest of the money). Second, the Republican-led House hasn't shown any willingness to fund high-risk pools. In fact, last year GOP lawmakers scuttled a bill pushed by House Majority Leader Eric Cantor (R-VA) to spend just $3.6 billion on high risk pools for under a year, fully paid for with cuts to Obamacare.
It's ironic, in a way, that it's come to this. The traditional Republican reform model, before the party's recent radicalization, was to ensure protections for those with pre-existing conditions by bringing everyone into the system through an individual mandate. Then President Obama announced he agreed with Republicans on this, which pushed the GOP further to the right, in search of something else -- a process that clearly hasn't gone well.
In Jindal's case, the result is a mess. He'd repeal the Affordable Care Act, effectively cancelling millions of Americans' health care plans, then scrap even more insurance plans by targeting employer-based care. In the process, he'd also scrap the ACA's financing, which necessarily raises questions about how the governor would pay for his already inadequate plan.
All the while, Jindal would try to turn Medicare into a voucher scheme, while throwing in some conservative boilerplate about "tort reform."
If Jindal is the best Republicans have to offer on health care policy, it's no wonder the party has struggled for nearly five years to put together an ACA alternative.