Political Animal


February 20, 2013 4:58 PM The GOP’s Ultimate Health Care Plan B

By Ed Kilgore

Because Republicans have spent so much time trying to erase their fingerprints on the blueprints for the Affordable Care Act, and pretending it’s “socialized medicine,” they haven’t done much thinking (in public, at least) about how to exploit the president’s huge concession of choosing a heavily private-insurance based model for quasi-universal coverage.

That changed with the Reuters column by Douglas Holtz-Eakin and Avik Roy today on “The future of free-market healthcare.” It’s a relatively straightforward analysis of how Obamacare’s health exchanges and subsidies can be used to undermine and eventually replace public health insurance programs:

[W]e should use the insurance exchanges in the service of Medicare reform. Instead of bothering with complex legislation, Congress should raise the eligibility age for traditional Medicare by three months each year — for the foreseeable future. Retirees will then gradually migrate into the exchanges’ premium-support systems.
Medicaid-eligible seniors should also be offered exchange-based coverage, to improve the quality and coordination of their care.
Fourth is to gradually shift the remainder of Medicaid’s low-income enrollees into the exchanges. Today, Medicaid recipients face a strong disincentive to seek work, because entry-level jobs can force them to give up their health coverage in exchange for modestly higher income. The exchanges would allow these workers to climb up the income ladder while maintaining their insurance.

The end result would be a fiscally sustainable, fully reformed set of entitlement and insurance programs that place American families in charge of their own health dollars. In other words, everything that conservatives have always wanted. And we’d have Obama, in part, to thank.

We’re going to hear a lot more of this sort of talk if conservatives decide they can’t sabotage Obamacare’s implementation or reverse its key provisions. Granted, earlier in the column the authors talk about eroding the insurance regulations that made Obamacare a coverage expansion in the first place, and significantly reducing the scope of its subsidies. Perhaps the best way to describe this strategy is as one that sells itself as a reform of the post-ACA health care system instead of a restoration of the pre-ACA status quo ante. But get used to it.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.


  • Ron Byers on February 20, 2013 5:14 PM:

    You are going to drive costs for seniors through the roof just at the time they are going on to fixed incomes. The Federal Government will pick up the difference which means the Medicare Advantage boondoggle will be saved. Hurray for the American insurance industry. Ain't freedom grand.

  • bcinaz on February 20, 2013 5:19 PM:

    I would rather support a program that subtracted 3 months every year for Medicare eligibility with every body eventually paying their premium dollars into Medicare funding, until we had Medicare for all. This would gradually phase out the insurance industry making it just one more job sector impacted by social and technological change.

  • golack on February 20, 2013 5:29 PM:

    Flip side of Kathleen Geier's earlier post--basically a move to a Japanese style system if I remember my Frontline correctly.

  • JR on February 20, 2013 5:54 PM:

    Okay, here's a big what-if... Assuming that (1) Obamacare is a success with the general public and (2) Democrats hold onto , at least, the White House and Senate in post-2016, what if his successor (HRC?) expands further towards single-payer coverage. With the number of GOP governors ceding health care to DC, it could be a possibility.

  • Joe Friday on February 20, 2013 6:49 PM:

    DHE: "Congress should raise the eligibility age for traditional Medicare by three months each year - for the foreseeable future."

    And every American should get a free Unicorn.

    So, the only way the Republicans can exploit the ACA is if the Dems go along.

  • Crissa on February 21, 2013 2:40 AM:

    Why exactly do we want retirees in the market for low-income jobs when unemployment is high, and hugely high for teens and twenties?

  • paul on February 21, 2013 9:10 AM:

    This is effing brilliant. If you hate people having healthcare. Because that means every year premiums will go up, either busting the bank for the federal government or making it more attractive to people to pay the penalty and gamble for a year or two.

    It's essentially importing Ryan's voucher plan (with guaranteed shortfall) to Obamacare.

  • memnAxiomma on April 23, 2013 9:18 AM:

    A tooth (plural teeth) is a small, calcified, whitish order initiate in the jaws (or mouths) of innumerable vertebrates and occupied to break down food. Some animals, explicitly carnivores, also exercise teeth for hunting or owing defensive purposes. The roots of teeth are covered sooner than gums. Teeth are not made of bone, but rather of multiple tissues of varying density and hardness.

    The ordinary structure of teeth is alike resemble across the vertebrates, although there is respectable converting in their shape and position. The teeth of mammals drink serious roots, and this pattern is also create in some fish, and in crocodilians. In most teleost fish, regardless how, the teeth are fastened to the outer surface of the bone, while in lizards they are fixed devoted to to the inner interface of the jaw alongside a man side. In cartilaginous fish, such as sharks, the teeth are seconded beside cold ligaments to the hoops of cartilage that type the jaw.