Orrin Hatch, mandater.
The most serious Republican alternative to Obamacare yet floated comes from Sens. Orrin Hatch (R-UT), Richard Burr (R-NC) and Rep. Fred Upton (R-MI), and it's
pretty much a rehash of a plan they cobbled together a year ago, that didn't go anywhere. That this plan is unlikely to go anywhere was
admitted by Burr, one of the co-authors himself. But, like I said, it's just about the only serious plan any of them have put out and so it gets looked at by wonks like those at the Urban Institute.
Funny thing the Urban people find, this Republican plan put forward because they hate Obamacare so much maintains the one thing they hate the most—the individual mandate. The Republicans just don't call it that.
Although those opposing the ACA have decried the burdensome nature of such a mandate, a recent proposal (the Patient Choice, Affordability, Responsibility, and Empowerment Act, or PCARE) developed by Republican Senators Orrin Hatch and Richard Burr and Representative Fred Upton seeks to address the same problem as the ACA's mandate and would impose strong penalties on the uninsured. Specifically, if individuals fail to maintain continuous coverage, they can be medically underwritten or effectively denied insurance in the nongroup market. Medicare Parts B and D also have provisions that penalize individuals for failing to promptly enroll in coverage for the same reason, yet this approach to an individual mandate has not been controversial. With the PCARE proposal, there now seems to be at least some agreement across the political spectrum that insurance markets cannot effectively operate while simultaneously treating individuals equitably regardless of health status (e.g., covering pre-existing conditions, no medical underwriting) if the healthy can obtain coverage whenever they choose. The consensus also appears to be that strong incentives to obtain and maintain insurance are required, although the details differ across the ACA, PCARE, and Medicare Parts B and D. Only the ACA is popularly referred to as an individual mandate, although that is, in fact, what all of them include.
All of which leads to this
tongue-in-cheek proposal from Jonathon Bernstein making pretty good sense. He argues that since they've already admitted that there's
lots of popular stuff in the law that Republicans love too, and would keep, they may as well just "replace" the whole thing by keeping the whole thing, but just renaming. "They could, for example, rename the health-care exchanges the Ronald Reagan Liberty Free Enterprise Insurance Zones or something like that," he suggests.
He's definitely onto something there, and it would sure make life a helluva lot easier for the handful of Republicans who actually do feel like they should legislate or something on this issue. Their basic problem is that there just isn't a way to do this thing and keep people who now have insurance happy, while also keeping the health insurance industry happy other than how Obamacare did it. Damn, reality does have a liberal bias.