A perfectly acceptable way to get health care, if you're a Republican.

A perfectly acceptable way to get health care, if you're a Republican.

This week House Republicans are messing around with yet another bill that would do something to damage Obamacare. This time, they want to allow insurers to keep selling shitty policies that don't cover all of the stuff that the law requires until 2019. Because what's another five years of people being underinsured and going into bankruptcy because of it? While they're dithering around with it, their most serious thinker on healthcare policy has been working on an actual plan that would replace Obamacare, in the event that Republicans could actually get their act together and achieve consensus on a plan.

But what Avik Roy, a writer at Forbes and the conservative Manhattan Institute and Mitt Romney's healthcare advisor, has come up with looks an awful lot like Obamacare. Except for the part where it forces people off of Medicare and Medicaid and into the private market. And the part where it would no longer be the Affordable Care Act. So says the Los Angeles Times' Michael Hiltzik.



How would the new exchange plans differ from those mandated by the ACA? For one thing, they would allow a broader range of premiums based on age, changing from the ACA's 3-to-1 limit to as much as 6-to-1. This would make the plans much more expensive for older customers. Roy would make all the plans stingier. The "actuarial value" of the current ACA plans ranges from 60% for the bronze tier -- that's the percentage of average healthcare costs covered by the plan -- to 90% for a gold plan. Roy would cut that to 40% to 85%. The benchmark silver plans would fall from 70% actuarial value to 55%. Roy would set the annual deductible for those plans at $7,000 for individuals and $14,000 for families. That could mean a huge expense for many families -- in California, the standard silver-tier deductible is $2,000 per person and $4,000 per family. That expense would be moderated by subsidies for lower-income Americans, but Roy would cut those too -- instead of subsidies available to households up to 400% of the federal poverty line, he would stop them at 317%. […] Roy's plan doesn't necessarily make healthcare delivery in the U.S. more efficient or cheaper overall. It reduces the burden on the federal budget by shifting costs to individuals, who may not be able to shoulder them.

Costs to the individual don't matter to conservatives, never have. Because everyone they know apparently can afford all the health care they need. You could argue that the whole exercise is little more than an elaborate ruse meant to do nothing but privatize Medicare and Medicaid (Roy would also raise the Medicare eligibility age by four months per year for the next 30 years).

What it is not is a reform that would make health care accessible and affordable to more Americans. There is no Republican plan that actually achieves what Obamacare does—make health insurance more affordable and more available. But again, that's not an issue for Republicans—they still don't see masses of people being uninsured as a problem that needs to be solved.

