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GOP's Health Law Alternative Could Be Messy As Obamacare

First lady Michelle Obama at an Affordable Care Act event in March.
Luis M. Alvarez
First lady Michelle Obama at an Affordable Care Act event in March.

Ever since Republicans began using the words "repeal and replace" back in 2010 to describe their intentions for the Affordable Care Act, they've faced a question: What, exactly, would they replace it with?

While there's currently no clear Republican alternative for the health care law, President Obama's signature domestic achievement, the House Republican leadership is signaling there will be one this year.

The signal came in the form of an interview The Washington Post's Robert Costa had with House Majority Whip Rep. Kevin McCarthy, the third-highest-ranking official in the House GOP's leadership.

The goal: give voters a clear way to distinguish the Republican and Democratic approaches as part of the GOP plan to bludgeon Democrats with the controversial health care law at every opportunity this midterm election year.

While there apparently isn't yet a detailed alternative to analyze, the concepts being considered as part of the proposed replacement are far from new. Indeed, they've been part of Republican alternatives from conservative think tanks like the American Enterprise Institute and the Heritage Foundation.

The final GOP package could include old standbys like health savings accounts, expanding state-run high-risk pools for the hardest-to-insure individuals, and the sale of insurance across state lines.

One immediate problem for Republicans is that these ideas don't exactly have buy-in from the insurance industry like, say, the individual mandate did, and without its backing, they would be hard to pull off.

Indeed, the insurance industry might be expected to fiercely lobby with its ample war chest against some, if not all, the GOP proposals.

"Every insurance industry executive I talk to thinks those proposals are silly," said Robert Laszewski, a health care industry expert, in an interview with It's All Politics. In a blog post, Laszewski explains industry officials' objections to GOP proposals, such as selling insurance across state lines.

Another problem for the Republican proposals is that they could undermine two of the health care law's most popular features — the ban against insurance companies declining to insure people with pre-existing conditions (or charging prohibitive amounts to do so) and the ability of parents to keep their children, up to age 26, on their insurance plans.

"Bingo," said Laszewski, when I raised this problem with him. When the ACA banned pre-existing conditions as a reason for not insuring someone, it obviated the need for the state-run high-risk pools, which is where people with pre-existing conditions formerly would turn.

A return to such high-risk pools would by definition mean revisiting a time when insurance companies used pre-existing conditions to exclude certain people.

"I can't imagine a Republican candidate wanting to go into a November election suggesting we go back on pre-existing conditions," Laszewski said.

Laszewski, no fan of how the Affordable Care Act was fashioned, is also skeptical of the Republican approach from what he's seen so far.

"I've been critical of the Obama people because they built Obamacare and they never really consulted people in the industry when they did it. That's one of the big reasons they got the mess that they do," Laszewski said. "And so here go the Republicans. Instead of doing something out of a left-wing think tank, the Republicans are doing it out of a right-wing think tank."

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Frank James joined NPR News in April 2009 to launch the blog, "The Two-Way," with co-blogger Mark Memmott.
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