Editorial Board

Yes, Republicans Can Help Improve Obamacare

Look past the focus on repealing Obamacare, and Republicans have ideas on health-care reform that are worth poaching.
Bobby Jindal raises his hand to help reform health care. Photographer: Andrew Harrer/Bloomberg

Louisiana Governor Bobby Jindal proposed an alternative to Obamacare this week. His blueprint follows on a plan from Senators Richard Burr, Tom Coburn and Orrin Hatch in January. And in the weeks ahead, more such Republican proposals are expected to emerge.

QuickTake Health Insurance Exchanges

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

Whatever the reason, 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 ACA.

Jindal's plan, for example, 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.

Jindal also proposes ending the tax exclusion for employer-sponsored health insurance, an accident of history that encourages higher consumption of health care and, consequently, 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. So Jindal's proposal could at least open a debate that's well worth having.

The proposal from Burr and his colleagues also deals with the tax exclusion, but in another way -- by limiting it to 65 percent of the cost of an average health plan. That, too, would be a big change, and it deserves consideration as a way to reduce spending. Democrats still stinging from criticism over the "Cadillac Tax," on the grounds that it will raise the cost of the most generous employer-sponsored plans, should welcome that discussion.

Another good idea from Burr and company is to automatically enroll in health-insurance plans any 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, further ideas to bring them into the market are needed.

Understandably, Democrats in Congress recoil at the suggestion that Obamacare should be repealed. But they shouldn't tune out Republican ideas to improve the law. Keep in mind that one of the law's most essential mechanisms, the mandate that all Americans obtain insurance or face a tax penalty, began as a conservative idea. Republicans have other proposals that are also worth poaching.

Health-care reform is a work in progress. Costs remain too high. And too many Americans still can't afford care. Good ideas for improving the law should be welcomed wherever they come from.

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    David Shipley at davidshipley@bloomberg.net

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