There’s Only One Big Thing That Matters About the Upcoming Republican Health Care Plan


Politico has gotten its hands on a leaked copy of a Republican health care plan. It’s a discussion draft of a bill that’s a couple of weeks old, but it still provides a good idea of what Republicans are thinking these days. Here’s my summary of Sarah Kliff’s summary:

  • Good news: Compared to previous plans, it’s better on pre-existing conditions; more generous in its funding of high-risk pools; generally cheaper for young people; and includes bigger tax credits than earlier Republican plans.
  • Neutral news: Loosens the list of “essential” benefits for all plans. This is generally better for healthy people and worse for sick people.
  • Bad news: Eliminates Medicaid expansion; cuts Medicaid funding; is terrible for the poor; and is far more expensive for older workers.

There’s other stuff (all Obamacare taxes are repealed, for example, which is great news for the rich), but I submit to you that these are pesky details. There’s really only one big thing that matters: how much the program costs.

Obamacare spends roughly $100 billion per year on subsidies to make health coverage affordable for the poor, and even at that premiums are too high for many people and deductibles are too high for almost everyone. Handwaving aside, there’s no way to produce a plan that’s even remotely useful with any less funding than Obamacare. That’s just reality.

If the funding is sufficient, we can all have a good time arguing over continuous coverage penalties, age ratios, essential benefits, and all that. If the funding is insufficient, it’s all just whistling in the wind.

Rumor has it that an outline of this plan was already submitted to the Congressional Budget Office, and the score they returned was so horrific that it never saw the light of day. So when Republicans do finally release a bill and a CBO score, just turn immediately to the section that estimates the ten-year cost. If it’s substantially less than a trillion dollars, you can skip the rest.