THE New York Times
lists a series of measures Republicans and associated groups say they will take to roll back or repeal Obamacare. Every single one of the proposed measures either increases the cost of health care and the size of the federal deficit, or has no effect on them. In order:
- Repealing the "1099 rule", which would require businesses to file 1099s for anyone to whom they paid $600 or more. Repeal of the rule is probably a good idea and is supported by Barack Obama and many Democrats, but
it would increase the cumulative deficit by $17 billion over the next ten years.
- Eliminating the provision requiring employers to contribute to the cost of insurance coverage. This will have no effect on the cost of health care, but will force employees to pay more for their health insurance. If the government then has to replace employers' contributions with more subsidies to make sure workers can afford to buy the insurance they're required to have, that would mean more government spending, which would increase the deficit.
- Eliminating the tax on high-cost employer-sponsored health plans.
This would raise the cost of health care and insurance, and
deprive the government of tens of billions of dollars per year in revenue, raising the deficit.
- Reducing or repealing a tax on manufacturers of medical devices. This would raise the deficit.
- Allowing states more freedom to define what sorts of insurance plans will be acceptable on their exchanges. This threatens to create a race to the bottom in standards for health insurance, but probably has no significant effect on the cost of health care or on the deficit.
- Reversing cuts to Medicare. The law envisioned cutting $500 billion out of Medicare over ten years. Whatever spending Republicans put back into Medicare adds to the deficit. Notably, the law envisioned cutting funding for Medicare Advantage's private-sector plans, because they're much more expensive than public-sector ones. Republicans want to continue giving taxpayer subsidies to private insurance companies.
- Eliminating the mandate that requires people to buy insurance, while keeping the law's provision that insurance companies can't refuse to cover people with pre-existing conditions. This is impossible. It would drive the entire private health-insurance industry out of business. Therefore, Republicans will not actually attempt to do this, whatever they're currently saying. The question is whether they can figure out some way to force Democrats to vote to keep the mandate, allowing Republicans to evade responsibility for having failed to repeal it. Based on Democrats' tactical astuteness over the past year, I would not put it past them to wind up kneeling in their own end zone on this sort of issue.
The article doesn't mention the fact that
Republicans are already trying to eliminate the most significant cost control on Medicare spending included in Obamacare: the Independent Payment Advisory Board, an expert panel which would have the power to reduce Medicare payments without congressional approval. Eliminating the IPAB would cost $15.5 billion in this decade, according to the CBO, but more importantly, it would scrap the most promising existing mechanism for bending down the cost curve on Medicare, which is the make-or-break fiscal problem facing America over the next 25 years. For months, the GOP has been complaining that Obamacare is a budget-buster, and then stripping out the cost controls that pay for it.
This isn't surprising. Cutting spending, especially Medicare spending, is unpopular. Still, the speed here is pretty striking. Voters elected Republicans with a mandate to shrink the budget deficit on Tuesday. These are their proposals.