By Scott Lemieux
Every major national Republican is sure that they want to repeal the Affordable Care Act. They are much less clear about what, if anything, they would do after stripping insurance from millions of people. Two plausible Republican nominees for president — Scott Walker and Marco Rubio — issued health care plans this week. And…let’s just say there’s a reason Republicans spend a lot more time on the “repeal” part of the “repeal and replace” equation.
Indeed, to call these positions “plans,” as opposed to gestures in the direction of having a policy alternative, is probably too generous. As Jon Chait of New York puts it, they are “not so much plans as skeletal descriptions of planlike concepts.” Still, even in larval form, Walker’s plan contains several elements that are common to most Republican health care proposals, and that if enacted would result in horribly unpopular policy disasters. Here are the main features:
End the individual mandate
Most individual components of the Affordable Care Act are popular; the requirement that people carry insurance or pay a tax penalty is not. And since the mandate was very nearly the lever that gave a conservative Supreme Court majority a pretext to declare the ACA unconstitutional, Republicans have also convinced themselves that it is one of the greatest threats to liberty ever seen. So it is inevitable that any Republican proposal will advocate eliminating it, as Walker’s does.
The problem is that the popular parts of the ACA can’t be divorced from the mandate. If people are permitted to free-ride, the health insurance market can’t work. Multiple states tried to initiate ACA-like reforms without a mandate, and it was a disaster — young and healthy people decline to buy insurance knowing they can get it if they fall sick, premiums increase, more people drop out, and the market collapses. This is why President Obama — who pandered during the 2008 primaries by putting forward a plan without a mandate — recanted as soon as he was in a position to actually try to get a law passed.
