Darrell Issa, chairman of the House Oversight and Government Affairs Committee, took to Twitter Monday to propose replacing Obamacare with an array of subsidized, state-based, market-driven comprehensive health-insurance options that are not linked to employment and don't penalize people for having pre-existing conditions.
If Issa's replacement ideal sounds a lot like Obamacare, it's because so many components of the Affordable Care Act were based on ideas originally developed on the right. Rebuilding Obamacare based on conservative market principles gets you ... something not that different from Obamacare. Issa's plan would be better than the one passed into law in 2010, he insisted, because it would be based on the Federal Employee Health Benefit Plan. Yet that plan is far more generous to consumers than Obamacare and would likely cost the government more were it extended to the uninsured population as a whole.
Here's what Issa proposed.
Let's take Issa's suggestions piece by piece.
"Use a competitive free-market choice to expand consumer choice"? Check —Obamacare does that through the health-insurance marketplaces that allow consumers to pick from an array of private plans that meet baseline standards. That's what make it different than a single-payer system where the government is the only insurer, the progressive pipe-dream for what health insurance should look like.
"Allow self-employed Americans access to the same type of group coverage available to businesses"? Check — Obamacare does that by creating exchanges where the group is a state government or the feds.
"Include insurance plans in all 50 states"? Check — Obamacare does that, through 17 state-run exchanges and 27 federally run state exchanges. Seven states have "partnership" systems. It's not totally clear from the graphic, but Issa supports the government offering health-insurance plans that are available across state lines. Obamacare does not provide that option.
"Guarantee coverage, regardless of health status, pre-existing conditions or age"? Check, check, check. That's the whole "getting rid of discrimination against people with pre-existing conditions" part of the plan. Obamacare ends at age 65, when people become eligible for Medicare, while the FEHBP plan can be continued for certain eligible employees into retirement. That makes the plan for federal workers a more generous perk than Obamacare. Also, as Josh Barro has pointed out, the FEHBP imposes more restrictions on insurers than Obamacare does, because it requires the same rates for people of all ages, while people who are middle-aged are charged more than the young under Obamacare.
Issa says his plan "Would not: Hurt small businesses with heavy fines and burdens, forcing them to reduce hours, lay off workers and cut benefits." But small businesses — those that employ fewer than 50 people — are already exempt from the mandate to provide insurance under Obamacare, so it's not clear what Issa is talking about here. Instead, Obamacare is supposed to provide those small businesses with tools to make it easier for them to purchase insurance for their employees by setting up marketplaces where they can go to find insurance for them, though the online roll-out of the small-business insurance marketplaces has been delayed.
Issa also says his plan "Would not: Break the federal budget by adding trillions of dollars to the deficit." "[T]his IS the system that members, staff and gov't officials use & it's a proven, low-cost model," Issa insisted.
But the only reason FEHBP is "low-cost" to consumers is that the federal government, as an employer, picks up about 75 percent of the premium tab for whatever insurance people pick through the system, according to the Office of Personnel Management.