Philip Klein and Jeffrey Anderson, writing respectively for the Washington Examiner and Weekly Standard, offer analyses of Bush’s plan that are largely consistent with my own: All three of us suggest that the plan reflects the emergence of a Republican consensus on what to do about health care post-Obama, and Anderson and I both favor that consensus while Klein expresses no opinion on it.
Both of them know this territory extremely well, but I may disagree slightly with Klein here:
[Bobby] Jindal’s deduction-based approach was actually the path pursued by Jeb’s brother, President George W. Bush, in his 2007 healthcare proposal. Jeb’s differing approach suggests he’s assumed that the ground has shifted since Obamacare expanded insurance coverage to millions of Americans and such a path is no longer viable, because deductions won’t benefit uninsured Americans who don’t have a large enough tax burden against which to deduct.
While the enactment and implementation of Obamacare strengthen the political case for a conservative health plan that enables nearly everyone to get coverage, a lot of conservatives favored that kind of policy before Obama took office. The 2008 McCain plan offered tax credits for everyone (and while conservatives had problems with McCain, nobody voiced any objections to that feature of the plan). Even the 2007 Bush plan featured a credit to help low earners get coverage, in addition to the deduction Klein mentions.
Jonathan Cohn, meanwhile, criticizes Jeb Bush’s plan at Huffington Post:
The Bush plan would weaken those standards on insurance: People buying coverage would have more freedom to buy less-generous policies that cover only catastrophic costs. And the tax credits that Bush would provide, by design, guarantee access only to these catastrophic policies.
That’s cheaper than subsidizing the “silver” plans that the Affordable Care Act treats as its standard — a result conservatives would certainly cheer. But without ACA levels of assistance, poorer people who want more comprehensive coverage probably wouldn’t have the money to buy it. Once they got sick, they’d be stuck with more punishing out-of-pocket expenses. And because these are people with lower incomes, they’d have less money to cover those costs.
I think this assessment overlooks two things. First, having more people paying out-of-pocket for such expenses might well restrain their prices. Second, the Bush reforms would make it possible for people to buy policies with lower deductibles than a lot of Obamacare plans because they would not be forced to buy coverage for routine care. So they might have fewer punishing out-of-pocket expenses when facing medical emergencies. Which means that the insurance would not just be cheaper, but in some ways better.