(Bloomberg View) — Jeb Bush’s new health care plan looks a lot like the plan Scott Walker embraced two months ago, which in turn looks a lot like the one Marco Rubio sketched in an op-ed article and the one touted by Sens. Orrin Hatch and Richard Burr and Rep. Fred Upton. That’s a good thing. It means that Republicans are finally reaching a consensus on what to do about health policy that draws on the best conservative thinking on the subject. Bush (for whose campaign my wife works) is helping to ratify that consensus.
All these plans aim to change federal tax, spending and regulatory policy to enable almost everyone to get insurance that covers, at a minimum, catastrophic health expenses.
People who don’t have access to employer-provided plans would receive a tax credit that they could use to buy coverage — and that coverage would no longer have to comply with all the mandates in President Barack Obama’s Patient Protection and Affordable Care Act (PPACA). In Bush’s version of the plan, older people would get a larger credit. The tax break for employer-provided coverage, meanwhile, would be capped, both to keep the tax code from rewarding the most expensive plans and to raise some of the money needed for the credits.
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People with pre-existing conditions would be protected by a regulation that requires insurers to offer coverage on the same terms to sick people and healthy people, so long as they had maintained coverage. That proviso is there to keep people from waiting until they’re sick to get insurance. Meeting that condition would be easier than it has been in the past, thanks to the tax credit.
Bush would also reform federal aid to state health care programs for poor people, to give them much more flexibility. States could, for example, pass along much of their funding to the recipients so that they could purchase private coverage.
Not all Republicans have accepted this consensus. Louisiana Gov. Bobby Jindal, for example, agrees that Republicans need a plan to replace Obamacare and thinks it should involve changing the way the tax code treats health insurance. But he disagrees with the other Republicans on two points. He would offer a tax deduction, not a credit, which would save the federal government money but enable far fewer people to buy insurance. And he would let people who have access to employer plans use the credit to leave those plans for the individual market — a step that would run the risk of destabilizing the employer market.