Comprehensive Republican health reform plans introduced in Congress
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).
Comprehensive conservative Obamacare replacement plans
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—released Best 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).
The forgotten history of George W. Bush’s comprehensive health reform plan
Too many people conveniently ignore that in his 2007 State of the Union message President Bush 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. On the contrary, President Bush’s health plan was declared “dead on arrival” by Democrats in 2007. Yet it is Republicans who were tagged as being uncooperative and intransigent when they resisted the misguided direction that Obamacare seemed to be headed.
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. Consider one of the newest market-oriented health reform plans put on the table by Jim Capretta and Douglas Holtz-Eakin. Compared to Obamacare, this plan would cost roughly the same amount yet cover 22% more (8 million!) uninsured. If there’s a superior alternative to the slow-motion train wreck now being implemented, why wouldn’t the President and Democrats in Congress want to seriously consider it as a replacement?
Of course even those willing to acknowledge Bush’s health reform plan then tend to counter with the claim that he wasn’t “serious” about his proposal. It was just a defensive move to defend Republicans in 2008 against the charge that the Republicans didn’t have a plan because they didn’t care about the issue (sound familiar). Those dubious about GWB’s “seriousness” about health reform should do the following thought experiment. Imagine that the Democrats in Congress had passed a bill containing the Bush administration’s health plan–no more, no less. Does anyone seriously believe GWB would have vetoed that bill? If not, I would argue his proposal was a serious one.