A History Of Republican Health Care Alternatives

Liberals say pervasively that Republicans have no alternatives to replace Obamacare, and that their only plan seems to be a voucher system. Given how abysmal the GOP has been at messaging, that narrative is now entrenched. Yet, the fact remains that Republicans doled out many bills reforming health care in America. Even George W. Bush offered alternatives to help curb costs and maintain the quality of care during his presidency. Democrats may not have liked their plans, but they exist nonetheless. Chris Conover at Forbes listed the Republican history on health care reform in his August 28 post. Let’s go down the line.

Let’s start with 5 comprehensive health reform proposals that have actually been introduced in Congress—some well before President Obama even was nominated for president, and all months before the House (11/7/09) or Senate (12/24/09) voted on what eventually became Obamacare.

Ten Steps to Transform Health Care in America Act (S. 1783) introduced by Senator Mike Enzi (R-WY) July 12, 2007.

Every American Insured Health Act introduced by Senators Richard Burr (R-NC) and Bob Corker (R-TN) with co-sponsors Tom Coburn (R-OK), Mel Martinez (formerly R-FL) and Elizabeth Dole (formerly R-NC) on July 26, 2007.

Senators Bob Bennett (R-UT) and Ron Wyden (D-OR) introduced the Healthy Americans Act on January 18, 2007 and re-introduced the same bill on February 5, 2009.

Patients’ Choice Act of 2009 introduced by Senators Tom Coburn (R-OK) and Richard Burr (R-NC) and Rep. Paul Ryan (R-WI) and Devin Nunes (R-CA) on May 20, 2009.

H.R. 2300, Empowering Patients First Act introduced July 30, 2009 by Rep. Tom Price (R-GA).

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Likewise, conservative market-oriented health policy scholars have developed a rich menu of potential replacement plans for Obamacare:

Individual Pay or Play proposed in 2005 by John Goodman; this is a minimalist version of a broader reform envisaged by Goodman built on converting the tax exclusion into universal tax credits.

Health Status Insurance originally proposed by John Cochrane in 1995.

Universal Health Savings Accounts proposed by John Goodman and Peter Ferrara in 2012. This combines fixed tax credits with individual pay or play and health status insurance concepts along with Roth-style Health Savings Accounts.

Fixed tax credits. A variety of proposals have centered on using fix tax credits to replace the current inefficient and unfair tax exclusion for employer-provided health benefits. Two good explanations of how that would work are here:

James C. Capretta and Robert E. Moffit, “How to Replace Obamacare,” National Affairs, no. 11 (Spring 2012).

James C. Capretta. Constructing an Alternative to Obamacare: Key Details for a Practical Replacement Program. American Enterprise Institute, December 2012.

Income-Related Tax Credits proposed by Mark Pauly and John Hoff in Responsible Tax Credits (2002) and endorsed by the American Medical Association. More recently, 8 scholars from Harvard, University of Chicago, and USC–Jay Bhattacharya, Amitabh Chandra, Michael Chernew, Dana Goldman, Anupam Jena, Darius Lakdawalla,Anup Malani and Tomas Philipson—releasedBest of Both Worlds: Uniting Universal Coverage and Personal Choice in Health Care (2013) which also is built around a model of individual health insurance subsidized with income-related tax credits.

Flexible Benefits Tax Credit For Health Insurance by Lynn Etheredge in 2001.

Near-Universal Health Insurance Exchanges proposed in 2001 by Sara Singer, Alan Garber and Alain Enthoven (covers only non-elderly).

Universal Health Insurance Exchanges proposed in 2013 by former CBO director Douglas Holtz-Eakin and Avik Roy (covers Medicare and Medicaid in addition to privately insured).

What about the Bush plan in 2007? Conover said that Dubya proposed:

[A] sweeping health reform plan that would have replaced the current tax exclusion for employer-provided coverage with standard tax deductions for all individuals and families. The Bush plan called for a tax deduction that would have applied to payroll taxes as well as income taxes. Moreover, if one were worried about non-filers, the subsidy could easily have instead been structured as a refundable tax credit in which case even those without any income taxes would have gotten an additional amount. This is the kind of policy detail that easily could have been negotiated had the Democrats been in a cooperative mood in 2007. They were not.

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What’s sad is that the Bush plan actually was superior to Obamacare when it comes to providing universal coverage. Remember, Obamacare actually does not provided universal coverage. The latest figures from CBO says that when it is fully implemented in 2016, Obamacare will cut the number of uninsured by only 45%, covering 89% of the non-elderly. Even if illegal immigrants are excluded, this percentage rises to only 92%. In contrast, the Bush plan (without a mandate!) would have cut the number of uninsured by 65%. But that’s ancient history.