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Why There's No Room for Compromise on Obamacare

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Common ground has repeatedly proved illusory in the health care debate. Republican Sen. Lamar Alexander and Democratic Sen. Patty Murray have struck a bipartisan deal to stabilize Obamacare’s exchanges, but it is turning out to be no exception to this rule. There’s a lot more in it for liberals than conservatives to cheer, and Republicans are keeping their distance accordingly.

Conservatives are supposed to get two wins. The first is the creation of “copper” plans within the Obamacare exchanges. Moderate Democrats have championed this idea as a way for consumers to buy plans with lower premiums and higher deductibles than others available on the exchange. But because the plans would still be subject to Obamacare’s regulations, they would still be a far cry from the low-cost catastrophic plans that conservatives would like to see on the market.

(Related: Lamar Alexander Keeps the Individual Health Rescue Fight Alive)

The deal also gives states a little more flexibility — but constrains that flexibility in a way that makes it valueless. States would have to show that any policy changes they make would lead to a comparable number of people having the same kind of comprehensive coverage that Obamacare seeks to foster. But that’s not the kind of coverage conservatives want to make the focus of public policy.

What conservatives generally favor is helping consumers choose from a menu of options that includes low-cost plans that protect people from the risk of major expenses related to medical care. These low-cost plans would not, however, help them to pay for routine medical expenses. The copper plans are close to the reverse of this goal, since they would cover routine preventive care (thanks to Obamacare’s regulations), but have deductibles so high that they would not protect against major expenses.

Sens. Alexander and Murray may well have tried and tried to devise a deal that gave both sides a real win. In health care, though, it is extremely hard to find one, because there is little overlap between liberal and conservative policy objectives. If you allow catastrophic plans, a lot of young and healthy people will choose them, and the comprehensive plans liberals prefer will have high premiums. So liberals see almost any step conservatives want to take as a way of undermining or unraveling Obamacare.

If the goal of health policy is making sure that as many people as possible have comprehensive insurance policies, then it requires a highly regulated and subsidized market: Obamacare, something like it, or something to its left such as a single-payer system. If conservatives accede to that goal, their only remaining role would be the unattractive one of making a system that does not reflect their preferences relatively cheap by making it relatively stingy.

Republicans have not been successful at replacing Obamacare, but they are not ready for a complete surrender. That’s why they are unlikely to go along with a deal that shores up Obamacare while doing nothing to move it in the direction they want.

—-Read Sudden Cost-Sharing Reduction End Could Thump Florida Blue on ThinkAdvisor.

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