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The Republicans' stumbling block in their campaign to "repeal and replace" Obamacare has always been the whole "replace" part, since the GOP fundamentally does not believe in the goal of the reform: affordable access to health insurance and health care for everybody. If you can't afford health insurance, that's really not their problem, and you probably did something to deserve being too poor for health care, anyway. They can't say that out loud, obviously, so they have a mess of policy ideas that they've been kicking around forever (tort reform, anyone?) and have glommed together to call it their replacement plan.

Ezra Klein compiles them, courtesy of Ben Domenech, who worked in George W. Bush’s Department of Health and Human Services.

  1. They want to end the tax bias in favor of employer-sponsored health insurance to create full portability (either through a tax credit, deductibility, or another method);
  2. They want to reform medical malpractice laws (likely through carrot incentives to the states);
  3. They want to allow for insurance purchases across state lines;
  4. They want to support state-level pre-existing condition pools;
  5. They want to fully block grant Medicaid;
  6. They want to shift Medicare to premium support;
  7. They want to speed up the FDA device and drug approval process; and
  8. They want to maximize the health savings account model, one of the few avenues proven to lower health care spending, making these high deductible + HSA plans  more attractive where Obamacare hamstrung them.

 [...] It’s a plan, for instance, to save money by making it so fewer Americans have access to comprehensive, government-provided health care. It’s a plan to cut costs by letting insurers offer far stingier, far higher deductible policies than they do today. It’s a plan to limit the ability of injured patients to sue. It’s a plan to hand Medicare over to private insurers. It’s not repeal-and-replace so much as repeal-and-do-something-else-entirely.

It's a plan to benefit the insurance industry and really no one else. Rather than making sure that insurance companies can't discriminate, can't cut you off for pre-existing conditions, and won't be forced to keep premiums affordable, it goes back the pre-Obamacare status quo, and makes it worse. Cross-state insurance sales? That means the state with the laxest insurance regulations sets the (low) standards for coverage for everybody. Want to keep the insurance you currently have? Good luck with that. Block granting Medicaid and voucherizing Medicare are the really mean ones, kicking millions of poor people out of Medicaid and making health for the elderly more expensive as they have to pay more and more out of their own pockets as their vouchers shrink.

And that's the point of this plan. They don't want to replace Obamacare. They just want to undo it. They don't want to reduce the nation's insane health care costs, because they don't think wasting so many health care dollars is insane as long as it's providing healthy profits for industry. If that means more people are priced entirely out of the system, that's just too bad for them.

Originally posted to Joan McCarter on Wed Apr 03, 2013 at 10:18 AM PDT.

Also republished by Daily Kos.

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