Rep. Billy Long (R-Mo.) boasted
on Twitter yesterday, "You've asked for it and tomorrow, House Republicans will release our plan to replace Obamacare." Whether or not this
actually constitutes a "plan," however, is open to some debate.
After six years of vague talk about a conservative alternative to the Affordable Care Act, House Republicans on Tuesday finally laid out the replacement for a repealed health law -- a package of proposals that they said would slow the growth of health spending and relax federal rules for health insurance. [...] In finally presenting one, Speaker Paul D. Ryan of Wisconsin and his Republican team did not provide a cost estimate or legislative language. But they did issue a 20,000-word plan that provides the most extensive description of their health care alternative to date.
Perhaps, but let's not grade on a curve. It was seven years ago this month that House Republican leaders began promising
to unveil a GOP health-care-reform plan, and for seven years, the party has done nothing except offer vague soundbites and vote several dozen times to repeal the Affordable Care Act, replacing it with nothing.
Or put another way, we've seen seven years of posturing on health care policy, but no actual governing.
The New York Times is correct that we now have an "extensive description" of the House Republican vision on the issue, but an "extensive description" does not a plan make. There's still no legislation; there are still no numbers; there's still no substance to score and scrutinize.
The Huffington Post summarized
the problem nicely: "Speaker Paul Ryan wants to replace 20 million people's health insurance with 37 pages of talking points."
The plan, which isn't legislation and is more like a mission statement, lacks the level of detail that would enable a full analysis, but one thing is clear: If put in place, it would almost surely mean fewer people with health insurance, fewer people getting financial assistance for their premiums or out-of-pocket costs, and fewer consumer protections than the ACA provides. It's difficult to be certain, because the proposal, which House Speaker Paul Ryan (R-Wis.) will talk up at the American Enterprise Institute in Washington on Wednesday, lacks crucial information, like estimates of its costs and effects on how many people will have health coverage. The document weighs in at 37 pages, which includes the cover, three full pages about how terrible Obamacare is, and two blank sheets.
As for the outline itself, the "plan" includes exactly what we'd expect it to include: tax credits, health savings accounts, high-risk pools that Republicans don't want to finance, transitioning Medicare into a voucher/coupon system, and the ability to buy insurance across state lines without necessary consumer safeguards and protections.
After seven years of study, GOP lawmakers are stuck with the same collection of ineffective ideas they've been pushing to no avail all along.
When House Speaker Paul Ryan (R-Wis.) announced plans to unveil a six-part "Better Way" governing agenda, he vowed
, "We're not talking about principles here. This is substance." That may have been the goal, but as of this morning, we're still left with "a starting point
" and "a broad outline
" on health care that will ostensibly help Republicans to work out the details later.
There's no great mystery here. Republicans haven't been able to come up with a credible reform package for some pretty obvious reasons: (1) they're a post-policy party with no real interest in governing; (2) health care reform has never really been a priority for the party, which would prefer to leave this in the hands of the private sector and free-market forces; and (3) trying to improve the system requires a lot of government spending and regulations, which contemporary GOP policymakers find ideologically abhorrent.
On this last point, New York
's Jon Chait explained
a while back, "The reason the dog keeps eating the Republicans' health-care homework is very simple: It is impossible to design a health-care plan that is both consistent with conservative ideology and acceptable to the broader public. People who can't afford health insurance are either unusually sick (meaning their health-care costs are high), unusually poor (their incomes are low), or both. Covering them means finding the money to pay for the cost of their medical treatment. You can cover poor people by giving them money. And you can cover sick people by requiring insurers to sell plans to people regardless of age or preexisting conditions. Obamacare uses both of these methods. But Republicans oppose spending more money on the poor, and they oppose regulation, which means they don't want to do either of them."
A Republican Hill staffer famously put it this way
in 2014: "As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act.... To make something like that work, you have to move in the direction of the ACA."
Which, of course, Republicans can't bring themselves to do. The result is a shell of a plan, like the one Paul Ryan is rolling out today.