Dude, where’s my Obamacare?

So Republican presidential candidates Marco Rubio and Scott Walker saw how much attention you can get from releasing a policy proposal, or at least a piece of paper that has policy ideas on it without any ideas on how exactly to follow through with them. In order to revitalize their respective campaigns, Senator Rubio and Governor Walker decided to release alternative “repeal and replace” Obamacare plans. Both plans are very similar and, as Jordan Weissman at Slate notes, are centered around three basic ideas:

“1. Allow Americans to buy coverage across state lines.

2. Give people who don’t get insurance through their employer a tax credit so that they can purchase a private plan.

3. Create special “high-risk pools” for the sick who can’t get coverage otherwise.”

Alright, so whenever we hear these ideas around a conservative-based healthcare reform plan, we get these same basic ideas. This is because conservatives believe that the problem with health insurance in America is not that it’s not universal in its coverage, or that unregulated health insurance markets (prior to the ACA) kicked people off of plans for no reason and charged insane prices for those with severe illnesses, or that only the wealthy will get good healthcare plans while everyone else is subjected to cheap insurance plans (read: insurance plans that do not cover anything). No, conservatives believe that the problem with health insurance is the cost. And of course, because they hate the idea of government-run health insurance, it doesn’t matter to them that Medicaid and Medicare are cheaper than private health insurance.

So what are they to do, really? I mean they obviously can’t admit that almost all of their Obamacare predictions have turned out to be nothing but falsehoods. They obviously can’t admit that the American people do NOT want to see Obamacare repealed. So what are the GOP presidential candidates to do?

The same thing they always do. Give the same ideas, pretend like the American people have never heard them before, and pretend that this plan will somehow not be a return to the pre-ACA days where insurance companies were not sufficiently regulated. So on the idea that somehow all of our problems with addressing the costs of health insurance will be solved if we simply let Americans purchase insurance across state lines, Tommy Christopher smacked down that nonsense a few years back:

“As it currently stands, health insurance companies must abide by the regulations in the state where the policy originates. If you sell insurance in New Jersey, your customers are protected by New Jersey’s regulations, which are very good. Under Bachmann’s plan, you could buy cheap insurance from a state with weak regulations, and not be protected by your state’s [regulations]. In fairly short order, every health insurance company would be headquartered in the same weakly-regulated state, and residents in other states, who favored strong regulations, would no longer have the choice to be protected by those regulations.”

So the way this idea plays out is the following: all young people will buy their insurance from North Dakota while all the old people will buy their insurance from New York. Want to know what happens next? Instead of having what we have now through Obamacare, an insurance pool that as Jonathan Chait notes “[transfers] resources from people who are rich and healthy to people who are poor and sick, so the poor and sick people can afford insurance…”, we will now have a dwindled insurance pool in which there will be far-less transfer payments to people who desperately need subsidies to buy health insurance.

As for the tax-credit idea, the purpose of this credit, as Sarah Kliff at Vox explains is to “slowly wind down what is known as the tax exclusion for employer-sponsored health insurance.” Kliff goes on to mention that since these employer-based healthcare plans are not taxed, the idea of taking this tax credit away to motivate people to search for new plans through private exchanges would be extremely unpopular. Moreover, as Jordan Weissman notes from the same piece I linked to above, the tax credit would (probably) be enormously expensive to fund, particularly because Walker and (maybe) Rubio would end the taxes that come with Obamacare.

The high-risk pool idea is perhaps the most laughable of all the components of their “plans”. This is not just because it’s an extremely inefficient way to deal with the problem that some people (i.e. extremely sick people) need more extensive health coverage than those who are healthy, but also because as Josh Barro said a while back, even Republican legislators hate this idea. Riddle me this, conservatives. What happens when President Walker (UGH) or President Rubio (UGH) repeals Obamacare and then attempts to replace it with this plan, but then Republicans refuse to endorse it because it offers even minimal amounts of transfer payments? Will Congressional Republicans shut down the government while a Republican is president? Will they continue to act like a bunch of insane people who offer only extremely cruel ideas for healthcare?

I don’t know and frankly I don’t want to know. I don’t even want to get into the idea of block-granting Medicaid, because it’s an idea too ridiculous to comment on and we’ve already had this debate before. But I do want to get one more thing established here with the launch of these healthcare plans by Rubio and Walker.

These plans are not only a viscous attack on the poor, sick and elderly. They are mostly an attack on women. But why, you ask? Simple. Republicans and conservatives hate Obamacare because it makes contraception required as a part of healthcare coverage. As Phil Galewitz notes at Cosmopolitan, “[t]he law requires plans to cover all FDA-approved birth control methods without co-pays. This includes pills, the Ring, the Patch, injectables (the Shot), implants, intrauterine devices (IUDs), and sterilization procedures.” This is the real reason why Republicans and conservatives hate Obamacare. Obamacare enables what Republicans and conservatives hate most; women being allowed the dignity to plan for being a mother on their own damn time. The fact that women can actually have a sex life without the consequences of an unwanted/unintended pregnancy. This is what keeps Congressional Republicans awake at night.

I know this is all pointless because Obamacare isn’t going anywhere. After two presidential elections, two bogus Supreme Court challenges and a dysfunctional Congress that somehow finds the time to hold symbolic votes to repeal the law 50-plus times, the ACA is here to stay. Hey, that rhymes!


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