The GOP Really Can Improve Obamacare

Governor Bobby Jindal has smart ideas to refine the health-care law
Louisiana Governor Bobby Jindal speaks at the Conservative Political Action Conference in National Harbor, Md., on March 6 Photograph by Cliff Owen/AP Photo

Louisiana Governor Bobby Jindal has offered an alternative to Obamacare. His blueprint follows a plan initiated by Republican Senators Richard Burr, Tom Coburn, and Orrin Hatch in January. More such GOP proposals are expected to emerge.

Why, four years after the Affordable Care Act was passed, are Republicans now offering alternatives? It may be thanks to enrollment on the state and federal insurance exchanges, which has rooted the law more firmly into the U.S. health-care system: It’s suddenly harder for opponents to denigrate it without suggesting what would be better.

More proposals from conservatives are to be welcomed. This is not because they could be used to upend the law—it makes no sense to start over from scratch—but because they may contain strategies to improve on the Affordable Care Act. Jindal’s plan includes two excellent ideas. The first is to let nurse practitioners and other medical professionals practice to the full extent of their abilities. This makes sense because it would drive down costs. He also proposes ending the exemption from taxes for health-care benefits provided by employers, an accident of history that encourages higher consumption of health care and makes it more expensive. Obamacare will tax high-cost plans starting in 2018; Jindal wants to scrap the exclusion altogether, replacing it with a tax deduction for all health insurance.

That would be a far-reaching change: It could signal the end to the widespread practice of obtaining insurance at work. The status quo, on the other hand, is peculiarly unfair. Americans with employer insurance get the benefit of a tax break while those who buy policies on their own do not.

A good idea from Burr and company is to automatically enroll in health-insurance plans Americans who are eligible for premium tax credits. At first glance, 7.1 million people signing up for exchange-based coverage might suggest that auto-enrollment is a solution to a problem that no longer exists. But with more than 30 million Americans projected to lack insurance even with Obamacare, there’s more to be done.


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