A Republican Obama Care?

They’ve done it! Paul Ryan, the Speaker of the House of Representatives, has been promising to produce the Republican’s alternative to the Affordable Care Act (ACA) for years. Finally, late last month, he unveiled what he called the Patients’ Choice Act (PCA).

And guess what? It appears to be very similar to the ACA! For instance, two of the most prominent concerns raised by opponents of the health care law involve price controls and the mandate to purchase insurance. So how does the PCA resemble the ACA in regards to these two concerns? And how does it differ?

First, let’s address price controls. The ACA stipulates that the premiums charged to older enrollees cannot be more than three times the costs that are charged to younger enrollees. The purpose of this three-to-one ratio is to place a cap on the premium costs paid by older enrollees, even if it results in higher premiums for younger ones.

Republican lawmakers have long criticized this provision as a government price control on a private service, i.e. a regulation that imposes terms that would better be established by the competitive market. So how does Paul Ryan’s plan affect this price control?

Believe it or not, the PCA simply tweaks the ratio by raising it from three-to-one to five-to-one. Despite this tweak, Ryan’s plan allows the price control to remain in our health care system.

Second, let’s address the ACA’s mandate to purchase insurance, which is possibly the term of the current law that is most reviled by Republican politicians. According to the ACA, the mandate employs the tax code to impose a financial cost on individuals who do not sign up for a health plan. At first glance, the Ryan plan appears to eliminate this burden.

But the PCA introduces an alternative burden that does not exist within the ACA. At the moment, health plans are not permitted to deny care to consumers if they are suffering from pre-existing medical conditions at the time they shop for coverage. Such denials would effectively refuse coverage to individuals who need it the most.

Under Ryan’s plan, however, such denials of care would only be forbidden if individuals maintain continuous coverage. In other words, although consumers without health insurance couldn’t be penalized by the tax code under the PCA, they could be denied coverage if they ever experience a need for medical care — and thus for medical insurance — in the future.

Is the threat of losing access to all medical care in the future equivalent to the burden of a tax penalty in the present? That question is a debatable one; reasonable opinions can differ about it. What is not debatable, though, is that the threat of losing access represents a type of mandate to purchase health insurance, even if it exists in a different form than a tax penalty mandate.

In other words, the PCA contains a significant price control. And it contains a mandate to purchase and maintain a health insurance policy. Conceptually speaking, isn’t it simply a Republican version of Obama Care?