As can be expected in a mid-term election year, last night’s State of the Union speech was a doozy. This time around, the President promised Americans everything from retirement security and tax reform, to immigration reform and of course, more “middle-class jobs” globalization has eliminated (never mind, of course, that Americans now are living a much higher standard of living than they ever did before). But the President also needed time to brag, and what better to brag about than his signature legislative achievement—more commonly known as Obamacare.
Indeed, the President did not shy away from claiming that nine million people have availed themselves of Obamacare’s health insurance exchanges and Medicaid expansion—three million in private plans and six million in Medicaid. This, of course, is only part of the story. Until March 31st, no one will know how many of the three million have actually paid their premiums. Moreover, the Medicaid enrollment number is difficult to attribute entirely to Obamacare—many of the enrollees would have enrolled with or without the law.
But the President did not stop there. He continued with the obligatory jabs at Republicans, noting that they have voted 40 times to repeal the law, and further reiterating that Republicans need “to say what [they’re] for, not just what [they’re] against.” Maybe the President was busy writing his State of the Union speech, or perhaps he was catching some shut-eye—but he clearly missed the most recent (and the most realistic) Republican alternative to Obamacare.
The Patient Choice, Affordability, Responsibility, and Empowerment Act (PCAREA) was released just a few days ago from Senators Tom Coburn (OK), Richard Burr (NC), and Orrin Hatch (UT). The proposed bill would essentially retool Obamacare—reduce subsidies, pare back rating restrictions, and replace the individual mandate with a “continuous coverage” requirement—while embarking on important reforms to Medicaid that would give current beneficiaries an option for higher quality coverage.
This bill, along with the Republican Study Committee’s proposal from last year, and Representative Tom Price’s Empowering Patients First Act of 2013, has staked out Republican ground on health care reform, in ways that amount to more than simply returning to the status quo. Indeed, this latest iteration would improve significantly on Obamacare’s unnecessary benefit mandates and restrictions on insurance rating practices.
Perhaps the President is correct that Republicans will never support Obamacare—and there are good reasons for their opposition. But the usual rhetoric of “Republicans have no reform plan” is no longer enough. Moving forward, these new alternatives may present a very real challenge to Obamacare—whether the President recognizes it or not.
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