A mere 48 months after the law was introduced, only 42 months after it was signed, with just two weeks until one of its main provisions takes effect, Republicans on Wednesday finally offered their alternative to the Affordable Care Act.
Which would be cause for genuine (if belated) congratulations, except for one thing: It’s not really an alternative. Understanding why can help clarify the United States’ seemingly endless debate about health care.
The Republican bill would give individuals tax deductions to buy health insurance, expand tax-free health savings accounts and limit insurance premiums for people with pre-existing conditions. What it wouldn’t do is expand coverage to the same number of uninsured Americans — about 25 million, according to the latest estimates — as Obamacare.
The most important achievement of the Affordable Care Act is that the law attains something like universal health care in the U.S., closing an indefensible gap between it and every other developed country.
That means any plan billed as an alternative has to meet only one definitional threshold: covering a similar number of Americans as Obamacare. To go a step further and be a better alternative, a proposal should cover a similar number of Americans at a lower cost or with fewer unwanted consequences. The documents Republicans released Wednesday are conspicuously silent on how many additional Americans would be covered.
Until now, the Republican “repeal and replace” strategy on Obamacare has been to pretend that an alternative to Obamacare exists without saying what it is. Wednesday’s proposal is the logical culmination of that cynical strategy: calling something an alternative, and hoping nobody notices that it’s not.