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H.R. 3121 - American Health Care Reform Act of 2013
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The prevailing liberal reaction to the plan has been to dismiss it. It isn't a serious alternative to the Affordable Care Act, they say, because it doesn't provide health insurance to as many people or offer the same protections to those with pre-existing conditions. Obamacare supporters expect the law to increase the number of people with insurance by 25 million. The Lewin Group has estimated that a tax deduction would increase that number by only about 9 million.
These criticisms are partly right. The Republicans should replace their tax deduction with a tax credit, which would have a higher value for people with low incomes and thus do more to extend insurance. Increasing the number of people with health insurance may not do much for their health — the evidence that it would is pretty weak — but it will make them more financially secure. That's especially worth doing because federal policy, by tying insurance to employment, has locked a lot of people out of health insurance markets and thus made them less secure.
Republicans should make two other modifications to the plan. People who have access to employer coverage shouldn't be allowed to use the tax deduction or tax credit to purchase health insurance on their own. Eventually we ought to move toward a system that's much less dependent on employers, but we should minimize the disruptiveness of this transition.
And medical malpractice reform, as popular as it is among Republicans, shouldn't be done at the federal level. Medical torts have traditionally been regulated by states, and states have the incentive to set their policies on it the right way because their residents will pay the price if they don't.
Even with these flaws, though, the Republican plan is superior to Obamacare. It's less coercive. It requires fewer taxes. It doesn't have as much potential to reduce full-time employment. And it's more likely to control costs, relying as it does on the power of competition rather than the guidance of Washington-based experts.
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