September 18, 2013

So House conservatives are planning to roll out their long awaited alternative to Obamacare, some three years after they first promised to do so — and after more than three dozen votes to repeal it.

The conservative alternative wouldn’t do nothing at all. It would improve matters in some limited ways. But it just isn’t an alternative to Obamacare. That is, if by “alternative,” we mean, “something that intends to accomplish roughly the same goal as the thing it would replace.”

That isn’t meant as snark. It’s really the key substantive point here. Because at bottom what all of this is about is that Republicans just don’t support the same policy goals on health reform that Democrats and liberals do — which is to spend federal money expanding the safety net and to fix the individual insurance market by expanding government’s role in overseeing it.

All of this comes by way of Larry Levitt, senior vice president at Kaiser Family Foundation. Here are the key points in the conservative alternative, as summarized by the Associated Press, along with Levitt’s take on them:

1) “Individuals who purchase coverage approved for sale in their state could claim a deduction of $7,500 against their income and payroll taxes, regardless of the cost of the insurance. Families could deduct $20,000.” The trouble with this, Leavitt says, is that deductions disproportionately benefit the rich. By contrast, Levitt notes, Obamacare gives low income folks subsidies in the form of tax credits, which disproportionately benefit the poor.

2) The conservative alternative includes a “commitment of $25 billion over 10 years to defray the cost of coverage for high-risk patients.” This is a reference to “high risk pools” to cover those with preexisting conditions. Levitt says this would, in fact, provide protection for some with preexisting conditions, but it would be “much more limited” than Obamacare’s protections. Ultimately that isn’t nearly enough money to fix the problem when compared to Obamacare’s subsidies. Obamcare also places stricter limits on industry discrimination to “make insurance more accessible to people who are sick” and to “make insurance pricing more uniform,” Levitt says.

3) The conservative alternative also includes ideas that have long been in the GOP health care arsenal, such as allowing insurance sales across state lines and caps on medical malpractice payouts. But health reformers have long thought such ideas just wouldn’t cover too many uninsured, and Levitt sees no exception this time.  “I wouldn’t imagine that this would result in more than a few million uninsured getting coverage,” he says.

The bottom line is that, as Amy Goldstein put it a few years ago, the GOP approach “favors the health-care marketplace over government programs and rules.” Obamacare is not the government takeover of conservative nightmares, but it does envision a more robust government role in expanding coverage — and as a result, it would cover a lot more people.

“The significant pieces of Obamacare are public money to help low income people afford health care, regulation of the insurance market to make it more accessible to people who are sick, and rules that make insurance pricing more uniform,” Levitt says. “The Republican alternative is not a solution to the problem of sick and low income people being locked out of insurance.”

Greg Sargent writes The Plum Line blog, a reported opinion blog with a liberal slant -- what you might call “opinionated reporting” from the left.