Maybe there is a short term CR/debt limit lift to allow time for a broader budget negotiation deal in the works, as the Republican defund-Obamacare-or-delay-key-parts-of-it in return for reopening the government argument appears to have disappeared. Paul Ryan has an op-ed that doesn’t even mention Obamacare–the original reason given for the shut down–but that lists some familiar items if you have followed the various grand bargain discussions: alter the deductible structure in parts A and B of Medicare, more means testing of the program and the like. Some reasonable policy in there, but what is still missing is a coherent Republican approach to health reform, defined as the answer to what to do about the uninsured, and how to address that while also seeking to improve quality and address costs throughout the system.
Ryan’s op-ed also doesn’t mention his own health reform plan the Patients’ Choice Act, introduced in May 2009, but not refined since. I remain puzzled that House Republicans never managed to muster an actual alternative that was carried through legislatively (pass it out of committee, CBO score, etc.) to something they claim to hate so much. And it is very hard to have a negotiation between an actual law–worts and all–and general platitudes, but no legislative details.
Title II of the Patients’ Choice Act has a general outline of issues like how to define benefits, how to enroll patients sans an individual mandate (via the use of soft mandates, or auto-enroll procedures), and at least acknowledges issues like insurance reform (though I believe ending pre-existing conditions inside state based exchanges only but allowing tax credits to flow inside and outside of exchanges, which is what the text calls for, is a fatal flaw). It is overly vague in other areas (about premiums it says exchanges shall develop methods to prevent the “imposition of excessive premiums” with no clarity as to how). It would have been hard for the Republican party to have marked up the Patients’ Choice Act, because the details are truly difficult.
It is a shame they never got around to this, as it would make a reasonable deal on health reform much more likely. Imagine if the Patients’ Choice Act had managed to outline a list of aggressive auto-enroll procedures for health coverage in exchanges that were similar in risk pooling terms to the weak individual mandate. The mandate that no one likes could be replaced, giving them political credit for a change, and letting us move ahead to implementation in a reasonable manner. The thing our country most needs for long range budget issues is to develop a way ahead on health reform that is the responsibility of both political parties, that we will actually try. What most prevents that is one side of the negotiation still being unclear about how they would address the biggest public policy dilemma of our time.