The Republicans have never stopped campaigning against Obamacare and now the candidates in the presidential race are drumming up the “repeal-and-replace” meme. Two of them, Scott Walker and Marco Rubio, are out with what they say are plans to replace the law, Mr. Walker going so far as to say that the first thing he does (presumably after nuking the Iran nuclear deal) is to send Congress a bill to R & R Obamacare. (Note to Mr. Walker: the president does not propose legislation. He can suggest it, but Congress initiates bills.)
At any rate, both proposals from the erstwhile healthcare reformers would get rid of popular parts of the bill such as eliminating caps on how much care the insured can receive or keeping children on their parents’ plans to age 26. But most importantly, it would strip away a lot of coverage for the poor and give it to the rich.
Governor Walker’s plan appears to be less generous for many poor Americans. It would roll back the Medicaid expansion that has provided free insurance to low-income adults. It would distribute tax credits to those with private coverage on the basis of age, not income. Such a system would be far simpler to administer: Every person 50 to 64 would be given $3,000 to spend on health insurance, while everyone 18 to 34 would get $1,200. Older people tend to have higher health care costs, and are charged higher insurance premiums, the argument for the age-based subsidy system. But it means that for people without a lot to spend on insurance, a comprehensive health plan may slip back out of reach. For others, an affordable plan might be so bare-bones that it wouldn’t kick in before a major health catastrophe.
Wealthier people, on the other hand, could fare better under this plan, as long as they’re healthy. They would get more federal money to buy insurance plans, and they would have the choice of buying cheaper, less comprehensive plans than those offered under Obamacare rules.
The plan could make it harder for people with prior illnesses to buy insurance. Under Obamacare, insurers have to offer the same products and charge the same prices to customers of the same age, regardless of their health histories. The Walker plan would offer similar protections for people who remain insured for their entire lives. But anyone with a major gap in coverage could later be either priced out of the insurance market or disallowed from buying certain health plans.
The Rubio plan shares some of the basics, but offers fewer details. His editorial says people would get tax credits to buy insurance, but he doesn’t specify how those tax credits would be calculated or what would happen to people with pre-existing health conditions.
The problem with repealing Obamacare is that it’s already become a part of the fabric of American life. Five years in and millions of people getting coverage would make it well nigh impossible for anything to happen to it without a major upheaval in the insurance industry and throw millions of poor people out of their insurance plans. To the Republicans, that’s a feature, not a bug.