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December 10, 2013 1:42 PM The Persistent Temptation of Insurance Exchanges

By Ed Kilgore

Brother Benen notes today a few examples of Republicans allowing as how there are good if limited features of the Affordable Care Act, including state-run insurance exchanges:

Yesterday, Sen. Ron Johnson (R-Wis.), who ran on an anti-ACA platform in 2010, stopped by National Review’s office and said he realizes his party’s repeal crusade is a bust. “We’ve got to start talking about transitioning,” the far-right Wisconsinite said.
He continues, “Am I opposed to state-based exchanges? No.” He thinks “it may be that they can be usable.” “I’m all for repeal,” he stipulates, “but it’s there. What do you do with what’s there? … We’ve got to start talking about the reality of the situation.”

Steve views this sort of admission as a sign of conservative acceptance that Obamacare may actually start working well, meaning that its structure must be accommodated by Republicans in the future. Maybe, but I think it’s more likely that something like the exchanges has always been part of conservative health care policy thinking (such as it is), particularly insofar as they contemplate the wholesale demolition of employer-based insurance. Even those who are hostile to risk-spreading understand that some mechanism for helping many tens of millions of Americans enter the individual market-place will have to be set up.

Beyond that, there is the abiding irony that what conservatives oppose as a system for the uninsured many of them actively favor for Medicare and/or Medicaid beneficiaries: a system of subsidized private health insurance purchased via some collective structure like an “exchange.” Back in February, Douglas Holtz-Eakin and Avik Roy laid out an entire “Plan B” strategy whereby Obamacare’s exchanges would be used to replace Medicare’s and Medicaid’s single-payer insurance with private insurance (the latter has actually already been semi-privatized in many states).

So I suspect Republicans are reassessing exchanges, in concept at least, for reasons other than their fear that Obamacare’s exchanges will be successful. It’s part of the same pirouette Mitt Romney had to perform in pretending that the Affordable Care Act as a whole was somehow alien to his own principles for health reform.

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.

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