Originally published Feb. 9, 2015.
U.S. Sen. Richard Burr is taking a lead role in the latest push to replace the Affordable Care Act with a more market-driven approach to health reform. The North Carolina Republican joined two other committee chairs last week in introducing a new version of a prior "repeal and replace" plan.
The Patient Choice, Accountability, Responsibility and Empowerment Act (Patient CARE) would repeal the coverage mandate that's part of the ACA and revamp the subsidized marketplace that helps low-income people buy health insurance. The act, co-authored by Sen. Orrin Hatch of Utah and Rep. Fred Upton of Michigan, would use the marketplace to replace Medicaid expansion, allow interstate insurance purchases and revamp the tax break for employer insurance.
Avik Roy, author of a leading plan to reform the ACA piece by piece, offers an in-depth look at how the new Patient CARE Act compares with the prior version and with his own plan. He's a fan of the Burr-Hatch-Upton bill, even though he contends his own plan is more practical because it doesn't require repeal of the ACA.
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"Both plans would offer better health outcomes for the poor, by allowing those on Medicaid to obtain tax credits for the purchase of private health insurance and health savings accounts," Roy writes. "Mostly importantly, both plans would cover more people than Obamacare, because they would drive down the cost of health insurance for those who can't afford it today."
For a more skeptical take, read this piece by the Huffington Post's Jeffrey Young and Jonathan Cohn.
"Republicans promote these changes as increasing 'choice' and 'flexibility' in insurance, claiming that they will result in less federal spending and that younger adults will pay lower prices," they write. "But each of these proposed changes would carry other consequences as well. Policies without full benefits, including 'junk' plans and mini-med policies, would return to the market. The same pricing practices that reduced premiums for 25-year-olds would jack them up for 60-year-olds, putting insurance out of reach for many older Americans."
The Brookings Institution also offers a pro and con perspective. Stuart Butler gives the plan "two cheers" as a viable plan for "addressing the impasse over the ACA and achieving health coverage goals that are widely shared," while Henry Aaron says it moves in the wrong direction by creating more holes in the health care system.