Evening Must-Read: Gregory Clark: Social Mobility Barely Exists, But Let’s Not Give Up on Equality
Morning Must-Read: Noah Smith: What We Talk About When We Talk About the Middle Class

Over at Equitable Growth: Covering the Rollout of This Year's Burr-Hatch-[Coburn/Upton] ObamaCare Replacement Proposal Properly: Focus

Over at Equitable Growth: I think, yet again, that this New York Times story on the Burr-Hatch-Upton ObamaCare replacement proposal would have been much better if it had been assigned to David Leonhard's The Upshot rather than to the New York Times's national news desk. The indispensable link that should be in Robert Pear's story but isn't is here. And it should have been compared to last year's equivalent

Robert Pear's article:

Robert Pear: G.O.P. Lawmakers Propose Alternative to Obamacare: "Three influential Republican members of Congress unveiled a comprehensive proposal on Wednesday to replace President Obama’s health care overhaul with an alternative that would halt the expansion of Medicaid and scale back subsidies for middle-income people to buy private insurance.... States would have more authority to specify the ‘essential health benefits’... the federal government would no longer require insurance policies to include coverage for maternity care. The proposal was devised by... Hatch of Utah... Upton of Michigan... and... Burr of North Carolina..."

Robert Pear does not provide a link to any piece of paper about the plan, not even to Burr, Hatch, and Upton's own op-ed.

Over at the Washington Post's Wonkblog, Jason Millman writes, much more usefully, that:

The GOP plan outlined by congressional aides Wednesday is similar to one that the senators offered last year, which the GOP never united around... no actual timetable yet for... writ[ing] a bill or hold[ing] hearings...

Indeed. Last year's plan and this year's plan are the same, save for three moderate substantive differences. Comparing:

reveals that:

  • This year, the regulation of malpractice insurance is no longer left to the states.
  • This year, the plan no longer promises to "blunt the worse" of ObamaCare's Medicare cuts
  • This year Cadillac Tax replacement is
    • no longer a modest cap of the employer-sponsored insurance tax break that begins at 65% of the cost of the current average high-option plan;
    • rather a generous exclusion from taxation of $12,000/year for an individual and $30,000 for a family.

Otherwise the documents are, substantively, the same.

There are a number of rhetorical changes from last year's document:

  • The subtitle of the document has been changed from "A Legislative Proposal" to "Lower Costs, More Choices".
  • In the first paragraph: "patient-centered" has been changed to "patient-focused"; "patients and taxpayers" has been changed to "patients, families, small businesses, and taxpayers".
  • A footnote has been deleted. The deleted footnote is: "We believe it was unfair and wrong that Obamacare effectively treated Medicare as a piggybank to pay for new programs. Certainly, Medicare is in dire need of structural reforms that will put the program on a sustainable path and prevent its insolvency. That’s why we each have supported a range of proposals that would help shore up Medicare’s financing. We believe these reforms should be adopted--as soon as possible--as part of blunting the worst of Obamacare’s cuts to providers and plans. Over the longer-term, we believe that broader changes to Medicare should be addressed in the context of larger bipartisan Medicare reforms that not only put Medicare on a sustainable path, but modernize the Medicare benefit for seniors."
  • The change of "patient-centered" to "patient-focused" appears to have been made throughout.
  • In the second paragraph, "common-sense patient protections" has been changed to "patient protections"; "mandates which drive up health-care costs" has been changed to "mandates".
  • In the bullets below the second paragraph:
    • "NO ONE can be denied coverage" has been changed to "no one can be denied coverage";
    • "'continuous coverage protection' that rewards individuals moving from one health market to another" has been changed to "'continuous coverage protection' for individuals moving from one health plan to another".
    • An added sentence: "An individual could not be medically underwritten, denied health coverage, or be forced to pay a higher premium solely because of a pre- existing condition if they were continuously enrolled in a health plan without a significant break in coverage."
  • In the third paragraph: "Empowering Small Business and Individuals" has been changed to "Empowering Small Businesses and Individuals".
  • In the bullets below the third paragraph:
    • "States would be allowed to use" has been changed to "States could elect";
    • "auto-enrollment to design sustainable insurance" has been changed to "auto-enroll into insurance plans";
    • "tax credits for individuals who have a health tax credit" has been changed to "individual's tax credit";
    • "high-risk pools will help patients who are otherwise without health insurance" has been changed to "high-risk pools could help patients";
    • "balancing the cost impact" has been changed to "reducing premiums".
  • In paragraph four: a typo--"patients'" where it should not be possessive--has been corrected; "long-term care insurance and COBRA" has been changed to "COBRA"; "on bipartisan proposals of the past" has been changed to "upon bipartisan proposals".
  • In paragraph five: "The Patient CARE Act envisions adopting or incentivizing states to adopt a range of solutions to tackle the problem of junk lawsuits and defensive medicine" has been changed to "The Patient CARE Act adopts common-sense reforms to tackle the problem of junk lawsuits and defensive medicine".
  • Paragraph six has been deleted, rewritten, and replaced:
    • The old: "While recognizing the role of the employer sponsored system in our health care system, it is also important to address the unfair tax treatment of individuals and families who do not receive the same tax preference as those with employer-sponsored health insurance. This proposal repeals the employer mandate in Obamacare, a major reason for employers dropping coverage, and leaves the employer deduction untouched. To help lower the cost of health coverage, the Patient CARE Act reduces a distortion in the tax code—the unlimited exclusion from a worker’s taxes of employer- provided health coverage. This proposal institutes a modest cap on the exclusion for the most generous high-cost plans; specifically, a cap at 65 percent of the average market price for a high-option plan. The cap would be indexed to grow at an annual rate of CPI +1."
    • The new: "We recognize that employer-sponsored insurance is an important feature of our health care system that provides coverage to nearly 150 million Americans, so we scrap the job-killing employer mandate and preserve the employer deduction. However, the open-ended tax preference encourages higher costs and increased spending. Our proposal maintains the employer deduction, so employers continue to have incentive to provide quality coverage to their employees. At the same time, we institute a cap on the exclusion for employees’ health coverage valued at a generous $12,000 for an individual and $30,000 for a family and index it at CPI+1 for perpetuity. Unlike the punitive Cadillac Plan Tax in current law which imposes an onerous excise tax of 40 percent on cost of coverage of health plans that exceed the annual limit, our proposal treats every additional dollar after the generous threshold at the individual’s tax rate--a more balanced approach for middle class Americans."

UPDATE: In email, Harold Pollack summarizes the provisions he knows of. The expansion of Medicaid is reversed, the individual and employer mandates to acquire and provide coverage dropped, and:

  • Subsides would go up to 300% of FPL [rather than 400%]... [adversely effecting] middle-class people even more.
  • Their own version of the Cadillac tax [on high-cost health plans]....
  • Ban on lifetime and annual insurance payment caps remains.
  • Young adult provision [for their remaining on their parents' insurance] kept, but states could opt-out.
  • HIPAA-type back-door individual mandate for those with continuous coverage, “a one-time open enrollment period in which individuals would be able to purchase coverage regardless of their health status or pre-existing conditions.”
  • lock-granted Medicaid,
  • Letting age gap to to 5:1 [rather than 3:1]
  • Various taxes in ACA repealed or reduced.

Another observer writes:

A non-shocking CBO score... [would] be because of cuts to Medicad--not the expansion, but cuts on pre-ACA Medicaid. Overall, just eyeballing it, it looks like 1/5 tax increase on the middle class, 4/5 benefit cuts for the poor, in exchange for no guarantee of health coverage at all...