Republicans have long been in agreement about the need to repeal the Affordable Care Act, and replace it with a health-care reform package that employs free market methods to reduce costs and increase coverage. This is an admirable and indeed critical goal. But in the rush to avoid being portrayed as “the party of no,” it is important to recognize that there is a right way to replace ObamaCare, and a wrong way. The proposal authored by Sens. Tom Coburn (R-Oklahoma), Richard Burr (R-North Carolina), and Orrin Hatch (R-Utah), and released as the Patient Choice, Affordability, Responsibility, and Empowerment Act (CARE) is a definitive example of the wrong way.
The Coburn-Burr-Hatch plan (CBH) does have a handful of positive characteristics. Title I of the proposal repeals the most onerous parts of Obamacare, including the much-reviled individual mandate, and for this it should be commended. As a whole, however, it retains far too much of the framework that makes Obamacare such a regulatory disaster.
To begin with, the plan restores many of the same administrative burdens that Obamacare imposes on private insurance companies. It still requires that insurers allow young adults to remain on their parents’ plans until age 26, and it introduces a slew of disclosure regulations that increase administrative costs for insurers. Additionally, while the overt requirement to accept patients with preexisting conditions is not included, insurers would be forced to take patients with such conditions who have been continuously covered by insurance for at least the past 18 months. That’s merely doing the wrong thing in a less wrong way.
The Affordable Care Act prohibited insurance companies from charging older patients more than three times the rate offered to younger ones. While the authors of CBH acknowledge that such a requirement is restrictive and forces costs up for young people, their plan would retain the regulation, merely substituting a ratio of five to one for ObamaCare’s three to one. This is a change of degree, not of principle, and the wrong approach to establishing a free market for healthcare.
While these regulatory burdens would likely pose little challenge to large, well-established insurance companies, the barriers to entry they create would discourage new and smaller firms from joining the market, ultimately harming competition, limiting consumer choices and keeping prices high. This is the wrong approach. We should be promoting competition, not restricting it.
The CBH plan further complicates the already bloated and distorted tax code by instituting a series of means-tested, age-based tax credits to individuals earning up to three times the federal poverty threshold, while at the same time capping the tax-free deductibility of health-care expenditures at 65 percent. This is effectively a large tax increase on workers who have access to employer-provided health insurance, and the phase out of the tax credits raises the implicit marginal tax rates on middle-income families.
Increasing taxes on the one hand while offering tax credits on the other is a redistributionist policy, far from the free market reforms the proposal’s authors’ claim. The means testing and age-based nature of these credits fails to end the current discrimination against the purchase of health insurance by individuals in the same way that a flat, lump sum credit that treats all Americans equally would.