Skip to main content

GOP health plans good for the rich

By Timothy Jost
January 3, 2014 -- Updated 1545 GMT (2345 HKT)
STORY HIGHLIGHTS
  • Timothy Jost: The first day of 2014 was a day to celebrate in our history
  • Jost: Despite promises of Obamacare, Republicans are critical or call for repeal
  • He says alternative proposals offered by House Republicans help the rich and healthy
  • Jost: As high cost sharing under Obamacare will be discussed, just look at GOP plans

Editor's note: Timothy Jost is a professor of law at Washington and Lee University.

(CNN) -- The first day of 2014 was a day to celebrate in our history -- it was the first time that all Americans could buy health insurance regardless of pre-existing medical conditions, thanks to the Affordable Care Act.

But despite the good news, criticism of the ACA continues. Some Republicans have eagerly identified individuals who are not happy with the ACA.

Sanjay Gupta: Better health not about Obamacare, it's about you

As 2014—a midterm election year—dawns, it is time to ask: What does the GOP offer other than negativism? What is the GOP alternative to the ACA, who would it help and who would it hurt?

Timothy Jost
Timothy Jost

Until now, the Republican war cry has been repeal, for which they have voted repeatedly. But ACA repeal is neither realistic, responsible, nor perhaps, even possible. The 10 titles of the ACA contain hundreds of provisions that reform Medicare payment, combat fraud and abuse, and improve health care quality. Many are already in place. Total repeal of the ACA would rip many threads already woven into the fabric of our health care system.

Opinion: When will we get the verdict on Obamacare?

A targeted repeal of the less popular provisions of the ACA, the individual and employer mandates and some ACA taxes and fees, might be more feasible. But revoking the mandates would disrupt insurance markets and repealing the taxes will increase the deficit.

Does the GOP have anything constructive to offer? The answer, sadly, is not really.

House Republicans have put forward two proposals -- the American Health Care Reform Act, sponsored by a majority of House Republicans, and Rep. Tom Price's Empowering Patients First Act. Both are lengthy bills that largely recycle longstanding Republican panaceas.

Fighting the 'contraception mandate'
Healthcare deadline extended

The American Health Care Reform Act would replace the ACA's income-based tax credits with flat dollar tax deductions. Tax deductions are valuable to high-income Americans with high tax rates, but offer little or nothing to the low-income Americans helped by the ACA.

The Empowering Patients First Act offers flat dollar tax credits that do not vary by age, geography, or health status—all of which could influence health insurance premiums. These tax credits might almost fully cover the health insurance premium of a young healthy male, but would be essentially useless to an older, low-income family, which would be left thousands of dollars short of the cost of basic coverage.

The American Health Care Reform Act touts health savings accounts as the solution to every problem, but tax-subsidized health savings accounts are also primarily of value to higher-income Americans and useless to Americans whose income is too low to be taxed and who lack discretionary income to invest in health savings accounts.

As the media spotlight high cost sharing under ACA plans in the coming months, it should ask how much higher cost sharing would be under the GOP plans. Conservatives, such as John Goodman, champion very high deductible policies, and Republican proposals, unlike the ACA, do not limit cost sharing.

By repealing the ACA, Republicans would reinstate pre-existing condition exclusions for many of the uninsured. The primary relief they offer to the uninsured with health problems are state high-risk pools. High-risk pools, however, are very expensive, and without massive federal support would be unaffordable to many Americans.

Exclusion of Americans from insurance coverage would also likely increase under Republican proposals to permit interstate health insurance sales, which could drive a race to the bottom in state insurance regulation. Association health plans have a history of undermining state reforms aimed at covering individuals and groups with pre-existing conditions.

Opinion: Why I signed up for Obamacare

One cannot imagine a GOP health care proposal that did not promise to place more barriers in the way of Americans injured by medical negligence who seek compensation. Although our medical litigation system could certainly use reform, proposals for change would reduce health care costs by only a small amount: half a percent, according to the Congressional Budget Office, including defensive medicine. Republican malpractice "reform" proposals may be politically popular, but do not address our health care system's real problems.

The GOP does not promise that if you like your insurance plan you can keep it, and with good reason. The vast majority of privately insured Americans are covered through their work. The American Health Care Reform Act would abolish current deductions and exclusions for employer-sponsored health insurance. This would not only be one of the largest middle class tax increases in American history, but could result in millions of Americans losing employer-sponsored insurance.

Whatever disruptions the ACA may cause in coming months, it moves us toward more comprehensive and affordable coverage for low- and middle-income and sicker Americans.

The alternatives proposed by House Republicans would be very disruptive, and unsurprisingly, benefit the healthy and wealthy. Americans must ask themselves: Who offers the most needed reforms for our health care system?

Follow us on Twitter @CNNOpinion

Join us on Facebook/CNNOpinion

The opinions expressed in this commentary are solely those of Timothy Jost.

ADVERTISEMENT
Part of complete coverage on
October 22, 2014 -- Updated 2101 GMT (0501 HKT)
Paul Callan says the grand jury is the right process to use to decide if charges should be brought against the police officer
October 23, 2014 -- Updated 1619 GMT (0019 HKT)
Theresa Brown says the Ebola crisis brought nurses into the national conversation on health care. They need to stay there.
October 21, 2014 -- Updated 2235 GMT (0635 HKT)
Patrick Hornbeck says don't buy the hype: The arguments the Vatican used in its interim report would have virtually guaranteed that same-sex couples remained second class citizens
October 24, 2014 -- Updated 1336 GMT (2136 HKT)
Paul Begala says Iowa's U.S. Senate candidate, Joni Ernst, told NRA she has right to use gun to defend herself--even from the government. But shooting at officials is not what the Founders had in mind
October 23, 2014 -- Updated 2208 GMT (0608 HKT)
John Sutter: Why are we so surprised the head of a major international corporation learned another language?
October 23, 2014 -- Updated 2154 GMT (0554 HKT)
Jason Johnson says Ferguson isn't a downtrodden community rising up against the white oppressor, but it is looking for justice
October 24, 2014 -- Updated 1621 GMT (0021 HKT)
Sally Kohn says a video of little girls dressed as princesses using the F-word very loudly to condemn sexism is provocative. But is it exploitative?
October 21, 2014 -- Updated 2006 GMT (0406 HKT)
Timothy Stanley says Lewinsky is shamelessly playing the victim in her affair with Bill Clinton, humiliating Hillary Clinton again and aiding her critics
October 23, 2014 -- Updated 1414 GMT (2214 HKT)
Imagine being rescued from modern slavery, only to be charged with a crime, writes John Sutter
October 21, 2014 -- Updated 1600 GMT (0000 HKT)
Tidal flooding used to be a relatively rare occurrence along the East Coast. Not anymore, write Melanie Fitzpatrick and Erika Spanger-Siegfried.
October 21, 2014 -- Updated 1135 GMT (1935 HKT)
Carol Costello says activists, writers, politicians have begun discussing their abortions. But will that new approach make a difference on an old battleground?
October 21, 2014 -- Updated 1312 GMT (2112 HKT)
Sigrid Fry-Revere says the National Organ Transplant Act has caused more Americans to die waiting for an organ than died in both World Wars, Korea, Vietnam, Afghanistan and Iraq
October 21, 2014 -- Updated 1851 GMT (0251 HKT)
Crystal Wright says racist remarks like those made by black Republican actress Stacey Dash do nothing to get blacks to join the GOP
October 21, 2014 -- Updated 2207 GMT (0607 HKT)
Mel Robbins says by telling her story, Monica Lewinsky offers a lesson in confronting humiliating mistakes while keeping her head held high
October 20, 2014 -- Updated 1329 GMT (2129 HKT)
Cornell Belcher says the story of the "tea party wave" in 2010 was bogus; it was an election determined by ebbing Democratic turnout
October 20, 2014 -- Updated 2012 GMT (0412 HKT)
Les Abend says pilots want protocols, preparation and checklists for all contingencies; at the moment, controlling a deadly disease is out of their comfort zone
October 20, 2014 -- Updated 0336 GMT (1136 HKT)
David Weinberger says an online controversy that snowballed from a misogynist attack by gamers into a culture war is a preview of the way news is handled in a world of hashtag-fueled scandal
October 20, 2014 -- Updated 1223 GMT (2023 HKT)
Julian Zelizer says Paul Krugman makes some good points in his defense of President Obama but is premature in calling him one of the most successful presidents.
October 20, 2014 -- Updated 0221 GMT (1021 HKT)
Conservatives can't bash and slash government and then suddenly act surprised if government isn't there when we need it, writes Sally Kohn
October 22, 2014 -- Updated 1205 GMT (2005 HKT)
ISIS is looking to take over a good chunk of the Middle East -- if not the entire Muslim world, write Peter Bergen and Emily Schneider.
October 20, 2014 -- Updated 1300 GMT (2100 HKT)
The world's response to Ebola is its own sort of tragedy, writes John Sutter
October 17, 2014 -- Updated 2033 GMT (0433 HKT)
Hidden away in Russian orphanages are thousands of children with disabilities who aren't orphans, whose harmful treatment has long been hidden from public view, writes Andrea Mazzarino
October 18, 2014 -- Updated 1722 GMT (0122 HKT)
When you hear "trick or treat" this year, think "nudge," writes John Bare
October 18, 2014 -- Updated 0442 GMT (1242 HKT)
The more than 200 kidnapped Nigerian schoolgirls have become pawns in a larger drama, writes Richard Joseph.
October 17, 2014 -- Updated 1345 GMT (2145 HKT)
Peggy Drexler said Amal Alamuddin was accused of buying into the patriarchy when she changed her name to Clooney. But that was her choice.
October 16, 2014 -- Updated 2043 GMT (0443 HKT)
Ford Vox says the CDC's Thomas Frieden is a good man with a stellar resume who has shown he lacks the unique talents and vision needed to confront the Ebola crisis
October 18, 2014 -- Updated 0858 GMT (1658 HKT)
How can such a numerically small force as ISIS take control of vast swathes of Syria and Iraq?
October 17, 2014 -- Updated 1342 GMT (2142 HKT)
How big a threat do foreign fighters in Syria and Iraq pose to the West? It's a question that has been much on the mind of policymakers and commentators.
October 17, 2014 -- Updated 1221 GMT (2021 HKT)
More than a quarter-million American women served honorably in the Iraq and Afghanistan wars. Now they are home, we have an obligation to help them transition back to civilian life.
October 16, 2014 -- Updated 2027 GMT (0427 HKT)
Paul Begala says Rick Scott's deeply weird refusal to begin a debate because rival Charlie Crist had a fan under his podium spells disaster for the Florida governor--delighting Crist
October 16, 2014 -- Updated 0407 GMT (1207 HKT)
The longer we wait to engage on Ebola, the more limited our options will become, says Marco Rubio.
October 15, 2014 -- Updated 1153 GMT (1953 HKT)
Democratic candidates who run from President Obama in red states where he is unpopular are making a big mistake, says Donna Brazile
October 16, 2014 -- Updated 0429 GMT (1229 HKT)
At some 7 billion people, the world can sometimes seem like a crowded place. But if the latest estimates are to be believed, then in less than a century it is going to feel even more so -- about 50% more crowded, says Evan Fraser
October 20, 2014 -- Updated 1653 GMT (0053 HKT)
Paul Callan says the Ebola situation is pointing up the need for better leadership
October 15, 2014 -- Updated 2245 GMT (0645 HKT)
Nurses are the unsung heroes of the Ebola outbreak. Yet, there are troubling signs we're failing them, says John Sutter
October 15, 2014 -- Updated 1700 GMT (0100 HKT)
Dean Obeidallah says it's a mistake to give up a business name you've invested energy in, just because of a new terrorist group
October 15, 2014 -- Updated 2301 GMT (0701 HKT)
Fear of Ebola is contagious, writes Mel Robbins; but it's time to put the disease in perspective
October 14, 2014 -- Updated 1744 GMT (0144 HKT)
Oliver Kershaw says that if Big Tobacco is given monopoly of e-cigarette products, public health will suffer.
October 18, 2014 -- Updated 1335 GMT (2135 HKT)
Stop thinking your job will make you happy.
October 15, 2014 -- Updated 0208 GMT (1008 HKT)
Ruben Navarrette says it's time to deal with another scandal involving the Secret Service — one that leads directly into the White House.
October 14, 2014 -- Updated 1125 GMT (1925 HKT)
Americans who choose to fight for militant groups or support them are young and likely to be active in jihadist social media, says Peter Bergen
October 13, 2014 -- Updated 1303 GMT (2103 HKT)
Stephanie Coontz says 11 years ago only one state allowed same sex marriage. Soon, some 60% of Americans will live where gays can marry. How did attitudes change so quickly?
October 14, 2014 -- Updated 2004 GMT (0404 HKT)
Legalizing assisted suicide seems acceptable when focusing on individuals. But such laws would put many at risk of immense harm, writes Marilyn Golden.
October 13, 2014 -- Updated 1307 GMT (2107 HKT)
Julian Zelizer says the issues are huge, but both parties are wrestling with problems that alienate voters
October 13, 2014 -- Updated 2250 GMT (0650 HKT)
Mel Robbins says the town's school chief was right to cancel the season, but that's just the beginning of what needs to be done
October 11, 2014 -- Updated 1543 GMT (2343 HKT)
He didn't discover that the world was round, David Perry writes. So what did he do?
ADVERTISEMENT