(Bloomberg View) — Republicans have been saying “repeal and replace Obamacare” for so long that it has started to sound like one of those ceremonial phrases that drop out automatically at opportune moments, like “hellohowareyou” or “thankyouhaveaniceday.” The party has conspicuously failed to actually coalesce around a plausible replacement plan, however, which has given these words the hollow sound of a Southern matron greeting a mortal enemy over mint juleps.
Unfortunately, when you’re running for president, polite nods to social necessity aren’t quite enough. We’ve known for a while that the serious contenders were going to have to release an actual plan, one with enough details to critique. And sure enough, this week, Scott Walker has done so, while Marco Rubio has penned a moderately detailed essay in Politico that tells us where his plan is likely to go. So what do they tell us about what the GOP is thinking?
Both Walker and Rubio are endorsing some version of the plan advanced by the 2017 Project, which would repeal Obamacare — the Patient Protection and Affordable Care Act (PPACA) — in its entirety, and then use age-rated, advance-refundable tax credits to help people buy health insurance.
Both would allow people to shop for insurance across state lines, which liberals argue would lead to a “race to the bottom” of insurers locating in the most lightly regulated states, and conservatives believe would cut back the cost tangle of regulatory burdens and ever-increasing legislative mandates to cover this service or that.
Both candidates endorse high-risk pools for people with pre-existing conditions, and would beef up health savings accounts — in Walker’s case, by adding a $1,000 refundable tax credit for anyone who opens one. Both also have nasty things to say about bailing out insurance companies.
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The biggest difference so far is in how they would reform our current, very expensive entitlements for the elderly and the poor.
Rubio endorses moving Medicare to a premium support model, which you might think of as a sort of Obamacare for the elderly.
Scott Walker focuses his reform efforts on Medicaid, which would be converted to a program for poor families like CHIP, which has a capped funding level rather than providing matching grants, with a more open-ended entitlement for people with disabilities and low-income seniors.
Walker also has some blandly-nice-but-unlikely-to-change-much things to say about unleashing innovation and encouraging wellness, which Rubio doesn’t have the space for in an op-ed format.
These are two of the three or four plausible front-runners, which suggests that this broad idea — converting Obamacare to a simpler, flatter tax credit — is gathering the momentum needed to make it the likely alternative Republicans profess come next year. Which means two things: Obamacare is now setting the terms of the debate. And that debate will ultimately be fought over who Obamacare is for.