Running Against Their Own Ideas

Chait watches as Republicans “turn from denouncing the health-care law for its lack of high-deductible insurance to denouncing the health-care law for its high-deductible insurance”:

Insurance plans with low premiums and high deductibles were a major centerpiece of conservative health-care thinking. Until quite recently, conservatives seemed to believe that Obamacare prevented such plans from existing, which was totally false. As they’ve come into existence, conservatives have transitioned seamlessly into denouncing these plans for their horrible, high deductibles.

Episodes like this one have grown so familiar that they’ve lost all capacity to surprise. Conservative health-care-policy ideas reside in an uncertain state of quasi-existence. You can describe the policies in the abstract, sometimes even in detail, but any attempt to reproduce them in physical form will cause such proposals to disappear instantly.

Drum piles on:

Republicans have spent years claiming that their preferred health care solution involves a combination of high-deductible health plans and tax-free HSAs. The idea is that your HDHP handles catastrophic illnesses, while the money you use for routine medical care isn’t taxed, which puts it on a par with employer health care. But their idea of “high deductible” has always been on the order of a few thousand dollars. A bronze plan under Obamacare typically has a deductible of $5,000 or more ($10,000 or more for a family). And while Obamacare doesn’t feature tax-free HSAs, it does feature annual premiums with much of the cost offset via tax credits. Conservatives will never admit this (and maybe not liberals either), but the end results aren’t really all that dissimilar.

Jonathan Cohn looks at where conservative and liberal health care policies diverge:

 “Giving consumers the choice of narrower physician networks and higher deductibles, in exchange for lower premiums, is a good thing,” [Avik] Roy says. “The problem with Obamacare is that people are trading narrower networks and higher deductibles for higher premiums. And that’s because of all the other stuff that Obamacare does to the insurance market.”

Precisely. The real difference between left and right now is the “other stuff” Obamacare does to the insurance market. And what’s that other stuff? It’s “guaranteed issue” and “community rating”—the requirements that insurers sell to anybody, regardless of pre-existing condition, with varying rates or benefits. It’s the creation of a minimum standard for coverage, so that all plans must cover at least 60 percent of the typical person’s medical bills and include a set of “essential health benefits” from hospitalization to mental health to rehabilitative services to maternity care. It’s the availability of generous tax credits, available to people with incomes as high as four times the poverty line and worth thousands of dollars a year in some cases. And it’s the individual mandate—the requirement that people pay a fine if they decline to get coverage when it is both available and affordable.

Ezra wonders what healthcare policies Republicans could possibly support:

One option was for Republicans to build as many of their ideas into the Affordable Care Act and force Democrats to take partial responsibility for these hideously unpopular, but fairly reasonable, ideas. They didn’t do that. Then Democrats picked some of the ideas up anyway. So Republicans again had a chance to focus their fire on the parts of the law they hated — like the Medicaid expansion — in the hopes of moving the health-care system in the direction they prefer. Instead, they’re aiming at the least popular policies in the law — which just so happen to also be the exactly policies that they support.

We’ll see whether Obamacare withstands the onslaught. But either way, once the assault is over, what kind of health policy will Republicans be left with? How can they propose anything that will cancel plans or raise deductibles or tighten networks? How can they propose anything at all?