Who actually likes the grievously misnamed Affordable Care Act?
Neither of the major-party presidential candidates like it: Donald Trump calls it a disaster, and Hillary Rodham Clinton supports repealing part of it, namely the unpopular tax on generous insurance plans that is intended to help pay for it. In December, 90 senators voted to repeal that so-called Cadillac tax; the tax was “delayed” — the delay may very well prove permanent — in the 2015 omnibus spending bill. Congressional Republicans have voted umpteen times to repeal the unpopular law, and in January, Congress finally sent a repeal bill to President Obama. He vetoed it, but he doesn’t seem to much like his namesake health-care program, either: He has repeatedly delayed enforcing the unpopular parts of it, handed out exemptions like condoms in a fifth-grade health class, blown past any number of legally required deadlines, and illegally allowed insurance companies to continue offering some non-compliant plans. The only people who seem to much care for Obamacare are the 3 million illegal immigrants living in California, where Governor Jerry Brown is working to extend Obamacare benefits to unlawful aliens prohibited by law from receiving them.
Speaker of the House Paul Ryan has some ideas that might interest the 54 percent of Americans who oppose the Affordable Care Act.
Ryan and his wonk brigade have been putting out a series of wide-ranging, thoughtful policy proposals covering a number of subjects — poverty, the economy, national security, the Constitution, and now health care, with tax reform next on the agenda — under the general heading of “A Better Way.” These have largely been good, solid, reform-oriented policy packages, not perfect by any stretch of the imagination (Ryan’s is a realist political agenda with the inevitable compromises, not a Mont Pelerin Society wish list) and his health-care proposal is of a piece with that.
There would be fewer federal mandates on employers, insurers, and consumers alike. The hated individual mandate would be repealed, as would – consequently — the mandate that insurers cover pre-existing conditions. Instead, insurers would be obliged to cover preexisting conditions only for those who had maintained continuous insurance coverage, which should be easier to do under a Ryan model that would make insurance truly portable rather than employer-based and that would provide direct assistance to individuals and families shopping for coverage. The Obamacare exchanges and their maze of rules and mandates would be replaced by something more closely resembling a true consumer market, though insurance will remain heavily regulated at the state level while the major federal entitlements and their payment rules act in effect as a form of federal regulation.
The Obamacare exchanges and their maze of rules and mandates would be replaced by something more closely resembling a true consumer market.
Some aspects of the ACA would survive: The very popular provision allowing young people to remain on their parents’ insurance plan until age 26 would remain, as would age bracketing that advantages older Americans, who vote in large numbers. The Ryan model has the potential to be very expensive, and Republicans are, at this point, a little fuzzy about the numbers. But a proposal need not be perfect, or even very close to perfect, to represent a radical improvement over the ACA, with its centralizing tendencies, its federal micromanagement, and its inhibition of a truly consumer-driven market for health insurance and health care. Ryan’s model would enable American families to purchase catastrophic health-care plans and in most cases much more than that, with additional funds available for out-of-pocket costs, but it would also put pressure on health-care consumers to pay attention to prices and to comparison shop — to act, in short, like consumers do in most any other market.
The Ryan model builds on successful reforms of the past and points us toward a more market-oriented, consumer-driven model, while addressing many of the complaints and fears that Americans have about their health-care system. The great Republican failure in the debate over Obamacare was insistence upon the status quo, with a hundred GOP grandees going on television to affirm that the United States enjoys “the greatest health-care system in the world.” Even if that were true, that doesn’t mean that Americans didn’t, and don’t, have legitimate complaints about it, particularly when it comes to the insecurity of coverage and the unpredictability of prices. Ryan has produced a reasonable model for assuaging many of those concerns, one that deserves support.