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August 14, 2014 12:47 PM Can a Conservative Health Plan Build on Obamacare?

By Ed Kilgore

Conservative health wonk Avik Roy is a persistent dude with a political problem.

Practically from the moment the Affordable Care Act was enacted, Roy understood that its insurance purchasing exchanges, if radically expanded, might actually provide a foundation for privatizing Medicare and Medicaid and moving to a quasi-universal system of publicly-subsidized private health insurance. Early last year he suggested this as sort of a Plan B strategy for dealing with Obamacare, assuming the Plan A approach of uprooting it entirely and plowing and salting the ground from which it sprang didn’t work out.

Now Roy is back with a fully developed health plan, published by the Manhattan Institute, that follows this same approach. But he’s got the same political problem as before: how do you convince Republicans that the hated Obamacare is actually the vehicle for fulfilling decades of radical dreams of privatizing Medicare and Medicaid?

From the introductory material for the plan, it appears Roy is really trying to thread the needle. In back-to-back paragraphs he insists his plan is compatible—“perfectly” compatible in one iteration—with the “repeal and replace” strategy that is now Republican orthodoxy, but has the added advantage of not actually requiring the “full and formal” repeal of Obamacare! How cool is that?

Aside from the logical problems with insisting that not repealing Obamacare is “perfectly compatible” with repealing it, Roy has a more basic problem: Republicans have never, ever reached general agreement on what kind of “replacement” for Obamacare they’d like to see. Some are attracted to approaches similar to Roy’s, but others are determined to dump Medicaid on the states and are probably reluctant at present to mess with Medicare, a program popular with the GOP “base.” More than a few conservatives aren’t convinced the federal government has any significant role to play in health care, even as the subsidizer of private insurance.

All of these problems are academic, of course, until such time as Republicans obtain the political capacity to impose their will on health care policy. But presumably their 2016 presidential nominee will need a “plan.” For both of those reasons, I’m sure the most important audience for Roy’s new efforts will be the 2016 GOP presidential field. I don’t know enough about Roy’s associations to have a clear idea who his horse might be; perhaps he aspires to making this a party-wide consensus initiative like the Ryan Budget was in 2012. It’s reasonably clear, however, that he hasn’t give up and pursued a Plan B to his Plan B.

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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