The Republican Replacement for Obamacare
The GOP is introducing a plan that would replace the health-care law they hope to defund.
By Andrew Stiles
As polls highlight the American public’s unease about President Obama’s signature health-care law, House Republicans on Wednesday introduced legislation to repeal and replace it completely with a plan of their own.
The bill, called the American Health Care Reform Act, is the product of a health-care working group convened by Representative Steve Scalise (R., La.), chairman of the 175-member Republican Study Committee (RSC).
“I think we’ve done a very effective job of pointing out all the things that are bad about the president’s health-care law, but people want to know what we stand for as well,” Scalise told reporters during a briefing at the National Review office on Capitol Hill. “The public, as they get more angry about the existing law, they are going to want to have something else to put in its place.”
The group, which had been working on the plan for several months, included several members of the Republican Doctors Caucus, including Representatives Phil Roe (Tenn.), Renee Ellmers (N.C.), John Fleming (La.), and Paul Gosar (Ariz.).
“We were all saying we needed to have an alternative and put it on paper, to allow people to compare and contrast,” Gosar tells me. “We have the expertise — those of us in the doctor’s caucus who have actually provided health care. These are real solutions based on years and years in the trenches.”
Democrats have routinely criticized Republicans for attacking Obamacare without proposing a viable replacement. The president repeated this argument on Monday during his address immediately following the deadly shooting at the Washington Navy Yard. “Remember, initially this was like repeal-and-replace, and the replace thing has kind of gone off to the wayside. Now it’s just repeal.”
In fact, Representative Tom Price (R., Ga.), an orthopedic surgeon and former RSC chairman, has proposed a comprehensive replacement bill for three years running. And now, Scalise and company plan to push for a full debate and vote on their legislation. They’ll even seek input from Democrats. “You can’t pass a bill that’s entirely done by one party that affects every person in the country,” Roe said. “We’re open to Democratic ideas and amendments. We can’t just shut out an entire party.”
The RSC’s legislation is similar to Price’s proposal, and contains many ideas that conservatives will find familiar. At less than 200 pages in length, it is considerably more digestible than Obamacare, a 2,700-page piece of legislation that’s now become a 7-foot-3-inch tower of red tape. “The American people want smaller bills that they understand,” Gosar says. “The more complex you get, the harder it is to define. You paint yourself into a corner, where the government is dictating everything.”
The American Health Care Reform Act would repeal Obamacare in its entirety, in order to “start with a clean slate,” Scalise said, but would strive to achieve similar goals — more affordable health care and increased access — and do so without mandates or tax increases.
The bill aims to create a more competitive market for health insurance by letting people purchase plans across state lines and allowing small businesses to pool together to negotiate lower rates. It would also amend existing law to increase transparency in payments and pricing so patients would have a better understanding of the cost of care and ultimately become more discerning consumers. “The American people are the best consumers in the world,” Roe said. “We will drive across five lanes of interstate to get gas two cents a gallon cheaper, so don’t tell me you won’t get the same thing [in health care].”
The plan seeks to “level the playing field” between consumers who receive insurance from an employer and those who purchase insurance on the individual market. The latter group would receive significant tax breaks to offset the cost of buying insurance: Individuals would be able to claim a $7,500 deduction against their income and payroll taxes for qualifying health plans, while families would be able to deduct $20,000. The legislation would also expand access to portable health savings accounts, and increase the maximum allowable contribution to such accounts.
The bill would increase federal funding for state high-risk pools, which insure people with especially expensive and preexisting conditions, by $25 billion over ten years, and would cap premiums in those pools at 200 percent of the average premium in a given state. It would also guarantee that individuals with preexisting conditions could move between insurance plans while maintaining coverage in the interim.
Medical liability law would be reformed to cap awards on punitive damages, as well as attorneys’ fees, in an effort to limit the common (and increasingly expensive) practice of “defensive medicine.” Federal funding for abortion coverage would be explicitly prohibited except in cases of rape, incest, and risks to the life of the mother.
The bill is being introduced as Republicans on Capitol Hill appear to have coalesced around a plan to tie a government-funding resolution to a permanent defunding of the president’s health-care law. While that particular effort is unlikely to succeed this time around, Democrats will no longer be able to accuse them of not having a replacement plan for Obamacare.
“This is a starting point,” Gosar says. “We want people to be able to offer their viewpoints, and we want to share this with the American people. We’re not scared of this issue, we love this issue.”
— Andrew Stiles is a political reporter for National Review Online.