Less than a week old and the Senate GOP Obamacare replacement changes


Republicans are getting a small taste of what it means to be proactive on health care reform.

As Dylan Scott at Talking Points Memo chronicled Friday morning, less than a week after three Senate GOP members released the Patient CARE Act (PCARE) one significant part has been quietly revised:

The original eight-page proposal released by the Senate Republicans — Richard Burr of North Carolina, Tom Coburn of Oklahoma, and Orrin Hatch of Utah — said that the new cap would be “65 percent of an average plan’s costs.” Health policy experts told TPM that this would likely result in a big tax increase on most Americans and some would probably lose their insurance.

Some time after the original proposal was released Monday, a new one-page explainer on the tax provisions appeared on Coburn’s website, below the link to the original proposal. And it included a huge change. The cap would now be “65 percent of the average market price for an expensive high-option plan” instead of just “an average plan’s costs,” as the original proposal said. The language in the original eight-page proposal had not been changed as of Thursday evening.

Since PCARE was announced on Monday there’s been considerable discussion from health care wonks, some of which was shared yesterday, and especially on Twitter. One other notable critique came from health care expert Ezekiel Emanuel in the New York Times on Tuesday, who accurately described that the Republican plan (as described on paper) would bring about a substantial tax increase for people who have employer-sponsored insurance (ESI). A private score from the new Center for Health and Economy then came out on Thursday. While clarifying some aspects (including that the cap on ESI was the biggest pay-for) there were enough caveats to the score that, even given the extremely preliminary nature of the results, we’re left with more questions than answers.

The subsequent alteration in the description of PCARE’s ESI cap, as Scott wrote, is “a huge change” that would affect the budgetary and coverage impact of the Act. Despite that and other nebulous details, as Jonathan Cohn wrote Friday morning, some conservatives are already declaring PCARE a resounding victory over the liberal health care reform approach; that, as Cohn writes, it has “all the goodies of liberal health care reform…but without the unpleasant parts.”

Frankly, that’s a joke. If anything the quiet change with huge implications after some cursory critiques, and just for a basic proposal on a website, underscores how difficult reform is — a lesson that the right has spent the last few years making sure Democrats knew all to well. As Cohn expertly deconstructs in his piece, PCARE as it’s described is far from being the Valhalla of health care reform. Trying to expand access and increase quality for everyone, with no inconvenience to anyone, and without raising costs for individuals, businesses, or disfavoring industries — all the while not blowing up the federal budget — is a fantasy.

Conservatives are doing themselves a disservice by spiking the ball just because they put pads on. Use whatever cliche you want, but comprehensive health care reform is nothing but trade-offs all the way down.


*Note: Originally posted at The McLean Parlor


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