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Good news: Republican members of the US Senate are excited to repeal and replace ObamaCare. Bad news: Even at this late date, they can’t decide on how to do so.
Via the WSJ, one plan comes from Senators Susan Collins (R-ME) and Bill Cassidy (R-LA), who describe it as an “an off-ramp” for the GOP and, likely, amenable enough to Democrats to overcome a filibuster:
The bill would take major decisions out of the hands of Congress and let states choose whether to keep the current law’s core insurance structure, with the promise that if a state opts out it will get the federal funding it would have received to enact its own ideas instead. […] The senators’ proposal, called The Patient Freedom Act of 2017, would effectively allow states to opt out of many of the provisions that form Title I of the Affordable Care Act, known as Obamacare, including the requirement that everyone must obtain health coverage or pay a penalty and an edict that insurers cannot charge older people significantly more than younger people.
States that do choose to drop the ACA would have to keep a handful of the requirements it imposes on insurance companies: that they allow parents to cover children as dependents up to age 26, pay claims without annual or lifetime limits, and issue policies to people with pre-existing conditions.
Those states could also choose to collect federal funds that, under the law, would have gone toward tax credits and the expansion of Medicaid eligibility, and use the money to give other health-care assistance to residents instead.
Another, bolder plan comes from Senator Rand Paul (R-KY). Via Reason:
Replaces the existing open-ended tax exclusion for employer-provided health insurance with a universal deduction on both income and payroll taxes that would provide the same level of benefit regardless of how an individual obtains their health insurance. […] The bill will also give “individuals the option of a tax credit of up to $5,000 per taxpayer for contributions to an HSA…. Removes the maximum allowable annual contribution, so that individuals may make unlimited contributions to an HSA….[and] Eliminates the requirement that a participant in an HSA be enrolled in a high deductible health care plan.”
[…] Paul’s bill also wants to make it easier for individuals “to pool together for the purposes of purchasing insurance” and thus “Amends the Public Health Service Act (PHSA) to allow individuals to pool together to provide for health benefits coverage through Individual Health Pools (IHPs). These can include nonprofit organizations (including churches, alumni associations, trade associations, other civic groups, or entities formed strictly for establishing an IHP) so long as the organization does not condition membership on any health status-related factor.”
To my mind, it’s embarrassing that the GOP hasn’t settled on something that would have been, more or less, ready to go last Friday. For reasons that I imagine are largely shared here, Paul’s plan strikes me as vastly superior: besides pushing federal health policy toward something that resembles an actual insurance market, anything that ends the tax discrimination against buying insurance directly immediately gets my attention. (“You had me at ‘universal deduction.'”) On the other hand, majorities are slim and Collins and Cassidy are likely right that we’ll need some Democratic defections.