Republican Obamacare Alternatives Would Have Been Worse

We hear so often that the Republicans have offered no alternatives to Obamacare that we think it must be true.  It isn’t. 

They presented at least two alternatives to the Affordable Care Act in 2009. 

And neither would be better than what we have today.  One would have had all the Obamacare implementation problems.  And the other would have insured no more than a thimbleful of people. 

The first was called the Patients’ Choice Act, offered by Paul Ryan.  The other was called the Affordable Health Care Act for America, offered by John Boehner.

Elements of the Ryan plan, which was introduced in the spring of 2009, will sound very familiar to you:

“The federal government partners with states to create State Health Insurance Exchanges.”

These exchanges became a core component of Obamacare, and would look exactly like the exchanges in place today.

“The Exchange would require all participating insurers to offer coverage to any individual – regardless of age or health history.”

Apparently no one in early 2009 thought that people with pre-existing conditions should be excluded from having affordable insurance.

“Plans offering coverage through an Exchange would have to meet the same statutory standard used for the health benefits given to members of Congress.”

In Obamacare, this standard became known as the ten essential health benefits.

Ryan also proposed “simple auto-enrollment” as his form of “not-quite-an-individual mandate.”

I’ll let Rep. Ryan explain exactly what he meant here.  “For patients who make no decisions [about whether to have health insurance], they would simply be automatically enrolled in a low-cost, high-deductible catastrophic health plan.”  “States could also use their DMVs or state income tax forms as vehicles for auto-enrollment.”

Rep. Ryan eliminated the deductibility of group health insurance premiums, but offered every individual a $2,700 tax rebate and every family a $5,700 tax rebate toward the cost of insurance and to finance this auto-enrollment.

These rebates became the more generous, but income-dependent, tax credits now offered by Obamacare.

Rep. Ryan also called for the creation of Accountable Care Organizations – which became law through Obamacare – to help restructure the health care industry. 

All of these provisions are reasons why President Obama could argue, fairly, that there were plenty of Republican fingerprints on the Affordable Care Act.

The similarities in Ryancare and Obamacare may be striking, but there were some big differences, too. 

If Ryancare had become law, there would have been no Medicaid expansion, and Medicare would have offered more private options.  Insurers would not have been subject to minimum medical loss ratio requirements, children would not have been able to remain on their parents’ insurance until age 26, there would be a federal takeover of the Medicaid long term care program, and there would be no new benefits for veterans.

But here’s what matters today and what Paul Ryan would like you to forget.  If his plan had been adopted in full, we would have the exact same set of problems with the health insurance exchanges as we do today – and then some.

But Republicans shifted away from the Ryan plan as more of it became part of Obamacare.  Their vision became smaller, and John Boehner offered a new plan in November of 2009.  He called for an expansion of high-risk pools for individuals and reinsurance programs in the small group market.

The Congressional Budget Office analyzed the Boehner amendment and came to the following conclusions.  Boehnercare would have had little or no positive effect on the cost of group health insurance.  And it would have reduced the number of uninsured people by a measly 3 million by 2019.

Paul Ryan and John Boehner love to throw stones at Obamacare and its exchanges today, but they are living in glass houses.

Because if either of their plans had become law, we would clearly be far worse off than we are today.

• With no Medicaid expansion, no minimum payout requirements for insurers, and costly risk pools the primary insurance option for people with chronic diseases, we would be looking at new exchange enrollments in the hundreds or thousands today, not the hundreds of thousands.  
• But tens of millions of people who currently have large group health insurance would be discovering that they were also being thrown into this new individual market because their employers could no longer deduct the cost of their premiums.
• And even in the best case scenario, we would barely be moving the needle on reducing the number of uninsured. 

Talk about a disaster.

Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/