The conservative case for the Affordable Care Act, Part II

Back in December, I wrote that the Ryan-Rivlin plan — which has become the great conservative hope for Medicare reform — mimicked the Affordable Care Act’s structure almost exactly. The Tax Policy Center noticed the same thing. And Alice Rivlin — who has lent her name and support to the Ryan-Rivlin plan — agrees.

Paul Ryan hasn’t been too eager to talk about this. My requests for interviews on the topic have been politely rebuffed. But Pat Garofalo managed to ask him the question at Thursday’s Playbook breakfast. “How I would do exchanges are very different than how Alice wants to do exchanges,” Ryan replied. “So Rivlin-Ryan didn’t get to the level of specificity of how these exchanges must be designed, because I have a different opinion with Alice on how they ought to be designed.”

I’m still trying to find out what that different opinion is. An exchange is simply a regulated marketplace where you can purchase different insurance products. There aren’t too many controversial design issues affecting their construction. And both Ryan and Rivlin thought their vision close enough to jointly endorse a proposal — a proposal that Rivlin thinks is identical to the Affordable Care Act. So either Ryan-Rivlin isn’t real and it’ll fall apart as soon as the specifics need to be hammered out, or Ryan is proving Rivlin right when she said that “even if he agreed with me, he couldn’t say so.”

For now, I think it remains safe to say that the theory behind Ryan-Rivlin’s Medicare exchange is the theory behind all exchanges — which is to say, the theory behind the Affordable Care Act. But watching Ryan try to deny that he’s aping the Affordable Care Act’s structure is telling. This comes only a week or two after Republicans were put on the defensive by the White House’s offer to let states opt out of the Affordable Care Act if they could come up with a plan that covered as many people, with as good insurance, at as low a cost. A few years ago, their plan was the Affordable Care Act — but it was called RomneyCare, or the Dole-Chafee bill. Then Democrats adopted their plan, and rather than view that as a victory for the conservative movement, Republicans abandoned it. Now their plan is either nothing at all or some variation of the Affordable Care Act that differs in ways they have trouble explaining.