Ever since Barack Obama signed the Affordable Care Act on March 23, 2010, the Republicans in Congress have tried to repeal it. This week's vote was their 50th attempt.
And yet, despite their unyielding opposition, their earnestness rings hollow to most Americans for the simple reason that they have not offered an alternative path to health care reform. Even the party's own strategists have chastised it for its negative approach, for failing to offer a plan of their own, for obstructing rather than leading.
Finally, their pleas have been answered -- in the form of the Patient Choice, Affordability, Responsibility, and Empowerment Act or "PCEREA," sponsored by Republican Senators Orrin Hatch, Tom Coburn and Richard Burr.
At long last, we can answer the simple question that Democrats have been asking Republicans since March 23, 2010: You got a better idea?
Unfortunately, the answer is a disappointing "no."
The ACA, better known as "Obamacare," has four major provisions: (1) a ban on price discrimination against sick people, (2) an "individual mandate" requiring everyone to purchase health insurance or pay a fine to the IRS, (3) tax credits for Americans who cannot afford to purchase insurance and (4) a Medicaid expansion for the poorest Americans who don't pay enough taxes to qualify for the tax credits.
The PCEREA does away with the first provision right off the bat. The most popular feature of Obamacare, the one that appeals to our basic sense of fairness, is the rule prohibiting insurers from charging different prices to different consumers based on health status. The Republicans would erase this rule, once again making insurance least affordable for the people who need it the most.
With the first provision gone, there isn't much need for the second one. This is what most people have trouble grasping about the individual mandate: As unpopular as it is, it's necessary in order to sustain the most popular part of the law. Without an individual mandate, a ban on price discrimination will simply result in insurers charging high rates to everyone, driving all but the sickest consumers out of the market. Insurers can only afford to charge reasonable rates across the board if healthy people are required to buy in.
The PCEREA replaces these two provisions with two new provisions called "continuous coverage" and "auto-enrollment."
Under "continuous coverage," Americans would be given a one-time opportunity to buy insurance at prices that aren't based on health status. So long as they keep this insurance plan for the rest of their lives, they'll never be discriminated against. If they miss this opportunity -- say, by being born after the window passes -- they can be discriminated against. If they lose their plan -- say, because they change jobs -- they can be discriminated against. Basically, "continuous coverage" is a con, a "first come, first serve" lottery that doles out the right to fairness like it's a privilege, a prize in some twisted game and then snatches it out from your hands if you fall on hard times or dare to exercise your freedom of choice.
Under "auto-enrollment," states can sign you up for insurance without your consent, but you can opt out. Basically, the Republicans are assuming that the problem with the insurance market is that Americans are so stupid that they aren't signing up for insurance that they need and can afford.
Astonishingly, the Republicans have simply taken the provisions of Obamacare and made them temporary -- and called it "reform"! We'll give you fair prices, but only for a little while. We'll require you to sign up for insurance, but only until you back out.
The third provision confirms this ploy. Just like the ACA, the PCEREA offers tax credits to Americans who purchase insurance on the individual market. The only difference is that the Republicans' tax credits are far less generous, helping far fewer people.
Finally, the PCEREA addresses Medicaid by restricting its availability to only certain types of Americans, apparently the ones whom the Republicans deem worthy: pregnant women, children, the disabled -- but not, for example, working parents. It would also change Medicaid into a block grant program, where it would get a chunk of money every year regardless of how much it needs, leaving most states with tremendous shortfalls during recessions and leaving patients out in the cold when they need help the most.
This last provision is just cruel, but the Republicans can slip it into the bill because the rest of the proposal looks so thoughtful and measured that they're hoping you won't notice that it will do almost nothing to address the serious problems ailing our health care system. It is little better than the status quo that existed before Obamacare -- and in that sense, they haven't really offered an alternative after all.
==========
An abbreviated version of this op-ed was published in Friday's South Florida Sun-Sentinel.