Skip to main content

GOP health plans good for the rich

By Timothy Jost
updated 10:45 AM EST, Fri January 3, 2014
STORY HIGHLIGHTS
  • Timothy Jost: The first day of 2014 was a day to celebrate in our history
  • Jost: Despite promises of Obamacare, Republicans are critical or call for repeal
  • He says alternative proposals offered by House Republicans help the rich and healthy
  • Jost: As high cost sharing under Obamacare will be discussed, just look at GOP plans

Editor's note: Timothy Jost is a professor of law at Washington and Lee University.

(CNN) -- The first day of 2014 was a day to celebrate in our history -- it was the first time that all Americans could buy health insurance regardless of pre-existing medical conditions, thanks to the Affordable Care Act.

But despite the good news, criticism of the ACA continues. Some Republicans have eagerly identified individuals who are not happy with the ACA.

Sanjay Gupta: Better health not about Obamacare, it's about you

As 2014—a midterm election year—dawns, it is time to ask: What does the GOP offer other than negativism? What is the GOP alternative to the ACA, who would it help and who would it hurt?

Timothy Jost
Timothy Jost

Until now, the Republican war cry has been repeal, for which they have voted repeatedly. But ACA repeal is neither realistic, responsible, nor perhaps, even possible. The 10 titles of the ACA contain hundreds of provisions that reform Medicare payment, combat fraud and abuse, and improve health care quality. Many are already in place. Total repeal of the ACA would rip many threads already woven into the fabric of our health care system.

Opinion: When will we get the verdict on Obamacare?

A targeted repeal of the less popular provisions of the ACA, the individual and employer mandates and some ACA taxes and fees, might be more feasible. But revoking the mandates would disrupt insurance markets and repealing the taxes will increase the deficit.

Does the GOP have anything constructive to offer? The answer, sadly, is not really.

House Republicans have put forward two proposals -- the American Health Care Reform Act, sponsored by a majority of House Republicans, and Rep. Tom Price's Empowering Patients First Act. Both are lengthy bills that largely recycle longstanding Republican panaceas.

Fighting the 'contraception mandate'
Healthcare deadline extended

The American Health Care Reform Act would replace the ACA's income-based tax credits with flat dollar tax deductions. Tax deductions are valuable to high-income Americans with high tax rates, but offer little or nothing to the low-income Americans helped by the ACA.

The Empowering Patients First Act offers flat dollar tax credits that do not vary by age, geography, or health status—all of which could influence health insurance premiums. These tax credits might almost fully cover the health insurance premium of a young healthy male, but would be essentially useless to an older, low-income family, which would be left thousands of dollars short of the cost of basic coverage.

The American Health Care Reform Act touts health savings accounts as the solution to every problem, but tax-subsidized health savings accounts are also primarily of value to higher-income Americans and useless to Americans whose income is too low to be taxed and who lack discretionary income to invest in health savings accounts.

As the media spotlight high cost sharing under ACA plans in the coming months, it should ask how much higher cost sharing would be under the GOP plans. Conservatives, such as John Goodman, champion very high deductible policies, and Republican proposals, unlike the ACA, do not limit cost sharing.

By repealing the ACA, Republicans would reinstate pre-existing condition exclusions for many of the uninsured. The primary relief they offer to the uninsured with health problems are state high-risk pools. High-risk pools, however, are very expensive, and without massive federal support would be unaffordable to many Americans.

Exclusion of Americans from insurance coverage would also likely increase under Republican proposals to permit interstate health insurance sales, which could drive a race to the bottom in state insurance regulation. Association health plans have a history of undermining state reforms aimed at covering individuals and groups with pre-existing conditions.

Opinion: Why I signed up for Obamacare

One cannot imagine a GOP health care proposal that did not promise to place more barriers in the way of Americans injured by medical negligence who seek compensation. Although our medical litigation system could certainly use reform, proposals for change would reduce health care costs by only a small amount: half a percent, according to the Congressional Budget Office, including defensive medicine. Republican malpractice "reform" proposals may be politically popular, but do not address our health care system's real problems.

The GOP does not promise that if you like your insurance plan you can keep it, and with good reason. The vast majority of privately insured Americans are covered through their work. The American Health Care Reform Act would abolish current deductions and exclusions for employer-sponsored health insurance. This would not only be one of the largest middle class tax increases in American history, but could result in millions of Americans losing employer-sponsored insurance.

Whatever disruptions the ACA may cause in coming months, it moves us toward more comprehensive and affordable coverage for low- and middle-income and sicker Americans.

The alternatives proposed by House Republicans would be very disruptive, and unsurprisingly, benefit the healthy and wealthy. Americans must ask themselves: Who offers the most needed reforms for our health care system?

Follow us on Twitter @CNNOpinion

Join us on Facebook/CNNOpinion

The opinions expressed in this commentary are solely those of Timothy Jost.

ADVERTISEMENT
Part of complete coverage on
updated 11:30 PM EST, Sun December 28, 2014
Les Abend: Before we reach a conclusion on the outcome of AirAsia Flight QZ8501, it's important to understand that the details are far too limited to draw a parallel to Flight 370
updated 8:27 PM EST, Fri December 26, 2014
The ability to manipulate media and technology has increasingly become a critical strategic resource, says Jeff Yang.
updated 11:17 AM EST, Fri December 26, 2014
Today's politicians should follow Ronald Reagan's advice and invest in science, research and development, Fareed Zakaria says.
updated 8:19 AM EST, Fri December 26, 2014
Artificial intelligence does not need to be malevolent to be catastrophically dangerous to humanity, writes Greg Scoblete.
updated 10:05 AM EST, Fri December 26, 2014
Historian Douglas Brinkley says a showing of Sony's film in Austin helped keep the city weird -- and spotlighted the heroes who stood up for free expression
updated 8:03 AM EST, Fri December 26, 2014
Tanya Odom that by calling only on women at his press conference, the President made clear why women and people of color should be more visible in boardrooms and conferences
updated 6:27 PM EST, Sat December 27, 2014
When oil spills happen, researchers are faced with the difficult choice of whether to use chemical dispersants, authors say
updated 1:33 AM EST, Thu December 25, 2014
Danny Cevallos says the legislature didn't have to get involved in regulating how people greet each other
updated 6:12 PM EST, Tue December 23, 2014
Marc Harrold suggests a way to move forward after the deaths of NYPD officers Wenjian Liu and Rafael Ramos.
updated 8:36 AM EST, Wed December 24, 2014
Simon Moya-Smith says Mah-hi-vist Goodblanket, who was killed by law enforcement officers, deserves justice.
updated 2:14 PM EST, Wed December 24, 2014
Val Lauder says that for 1,700 years, people have been debating when, and how, to celebrate Christmas
updated 3:27 PM EST, Tue December 23, 2014
Raphael Sperry says architects should change their ethics code to ban involvement in designing torture chambers
updated 10:35 PM EST, Tue December 23, 2014
Paul Callan says Sony is right to call for blocking the tweeting of private emails stolen by hackers
updated 7:57 AM EST, Tue December 23, 2014
As Christmas arrives, eyes turn naturally toward Bethlehem. But have we got our history of Christmas right? Jay Parini explores.
updated 11:29 PM EST, Mon December 22, 2014
The late Joe Cocker somehow found himself among the rock 'n' roll aristocracy who showed up in Woodstock to help administer a collective blessing upon a generation.
updated 4:15 PM EST, Tue December 23, 2014
History may not judge Obama kindly on Syria or even Iraq. But for a lame duck president, he seems to have quacking left to do, says Aaron Miller.
updated 1:11 PM EST, Tue December 23, 2014
Terrorism and WMD -- it's easy to understand why these consistently make the headlines. But small arms can be devastating too, says Rachel Stohl.
updated 1:08 PM EST, Mon December 22, 2014
Ever since "Bridge-gate" threatened to derail Chris Christie's chances for 2016, Jeb Bush has been hinting he might run. Julian Zelizer looks at why he could win.
updated 1:53 PM EST, Sat December 20, 2014
New York's decision to ban hydraulic fracturing was more about politics than good environmental policy, argues Jeremy Carl.
updated 3:19 PM EST, Sat December 20, 2014
On perhaps this year's most compelling drama, the credits have yet to roll. But we still need to learn some cyber lessons to protect America, suggest John McCain.
updated 5:39 PM EST, Mon December 22, 2014
Conservatives know easing the trade embargo with Cuba is good for America. They should just admit it, says Fareed Zakaria.
updated 8:12 PM EST, Fri December 19, 2014
We're a world away from Pakistan in geography, but not in sentiment, writes Donna Brazile.
updated 12:09 PM EST, Fri December 19, 2014
How about a world where we have murderers but no murders? The police still chase down criminals who commit murder, we have trials and justice is handed out...but no one dies.
updated 6:45 PM EST, Thu December 18, 2014
The U.S. must respond to North Korea's alleged hacking of Sony, says Christian Whiton. Failing to do so will only embolden it.
updated 4:34 PM EST, Fri December 19, 2014
President Obama has been flexing his executive muscles lately despite Democrat's losses, writes Gloria Borger
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT