Sen. Tom Coburn, M.D.

Since President Obama and the Democrats effectively adopted what was the old Republican/health insurance industries health care reform plan the lingering question has been: Can Republicans come up with a new plan to really expand coverage that is not basic Obamacare. We got the answer today in the form of the Patient Choice, Affordability, Responsibility and Empowerment Act put forward by Sen. Tom Coburn (R-OK) Richard Burr (R-NC), Orrin Hatch (R-UT).

The proposal is sorta like a heavily stripped down version of the Affordable Care Act with work-arounds for some of the elements that are most politically toxic among the Republican base. It has few regulations, less money spent helping people, and less new bureaucracy. There is no individual mandate nor exchanges, but at its core it is about encouraging lower income Americans to use tax credits to buy regulate private insurance.

While the ACA has guaranteed insurance the GOP plan has a “continuous coverage” protection. You can’t be charged more based on your health as long as you maintained minimum coverage. This is also kind of a replacement for the unpopular individual mandate by encouraging healthy people to always have coverage.

The GOP plan would provide tax credits for people up to 300% of FPL [Federal Poverty Level] to help buy insurance instead of 400% under the ACA. The law would also allow states to automatically enroll people in default plans that are equal to the value of the tax credit. Again this helps eliminate the need for an individual mandate.

Instead of setting age bands at 3 to 1, the GOP plan would let companies charge older people up to five times as much.

Medicaid would be turned into more of a block grant style program and individuals would have the option to opt to buy private insurance instead with their tax credit.

Similar in concept to the Cadillac tax in the ACA the GOP plan would be paid for by capping the tax exclusion of employer plans at 65 percent of an average plan’s cost.

Without official language and a CBO score it is impossible to properly judge the plan. The devil is in the details, but so far it comes across more serious than other recent Republican proposals.

It at least takes steps towards addressing insurance affordability instead of pretending that is not even a problem the government should try to fix. It would also spend a significant amount helping people buy insurance. There are even a few small elements that are worth considering, but overall it reads as just a much stingier and worse version of the basic “consumer-driven” health insurance expansion that is the foundation of the ACA.

I’m left questioning how much these senators are really committed to this proposal because if they were willing to actually negotiate with Democrats back in 2010 they probably could have gotten a lot of these provision in exchange for their votes.

Photo by Medill DC, used under Creative Commons license