After weeks of cloak and dagger, Senate Republicans have finally unveiled their plan to replace Obamacare and now we know why they worked on it in secret.
When Republicans in the House released their plan in March, I wrote here that they had managed to unite health care commentators from the left and the right in consternation.
Leftists were appalled that Republicans would make health care cheaper for rich Americans and leave those who depend on Obamacare in the cold.
Conservatives were disappointed that the plan only eliminated the individual mandate but kept other parts of Obamacare in place, including its federal subsidies and insurance plan requirements.
The same criticisms can be made of the Senate plan.
From the poor to the rich
Republicans would phase out Barack Obama’s Medicaid expansion after 2021 and reduce the eligibility for subsidies, potentially putting health care out of reach for both low-income Americans and middle-income families who cannot afford unsubsidized insurance.
At the same time, Republicans propose to eliminate the taxes the Democrats passed to pay for Obamacare. So the poor lose their health care and the rich get a tax cut.
In the words of The New York Times: “shifting dollars from poor to rich is a key part of the Senate health bill.”
Like the House version, the Senate plan would allow state governments to change — but not abolish — requirements which have made insurance needlessly expensive.
For example, Obamacare forced all Americans to insure against the costs of childbirth and psychiatric treatment. Even if they’re male. Even if they have no history of mental illness.
Why leave this to the states? Who not leave it up to insurers and consumers?
The worst thing, from a long-term perspective, is that neither Republican proposal would seriously control rising health costs.
Conservatives have years argued for weakening licensing requirements, which could allow nurses to perform simple medical procedures, and creating a nationwide insurance market. Neither is in the Republican proposals.
To be fair, much of this is due to excessive regulation at the state level. But Republicans control most state governments. They have the power to lead a national effort to harmonize rules and cut costs.
But that would take more than slogans. That would take a serious, years-long commitment to improving health care for all Americans. It would require a willingness to face down interest groups, including those lobbying for doctors, which few legislators have the courage to do.
I would go further. The whole American system of enabling insurance through employers is illiberal. The tax system ought to be changed to turn those incentives around. You shouldn’t lose your health insurance when you lose your job, nor should you be afraid to quit your job because you can’t afford to lose your health insurance.
A party that prizes personal responsibility would make this their top priority.
Instead, the best Republicans can come up with is giving higher incomes a break and taking help away from those who need it the most.