On last Thursday’s debate stage, Donald Trump spoke vaguely about allowing insurers to sell across state lines and was met with jabs on his lack of a comprehensive approach to replacing Obamacare.
“What is your plan? What is your plan on health care?” Sen. Marco Rubio asked. “You don’t have a plan. I’ll give him one minute of my time to propose a plan.”
A week later, Trump has a seven-point plan to showcase, one that was added to his website just 24 hours before Thursday’s Republican face-off. But some say the proposal isn’t a detailed alternative to the Affordable Care Act—and that none of the GOP candidates have in-depth, comprehensive health care plans. That’s by design, it isn’t surprising, and it isn’t new, several health experts said.
A detailed plan invites criticisms of the proposal. It leads to questions on financing. And it boxes a candidate-turned-president into policy pledges they made during their campaign.
Perhaps most notably, for Republicans, health care isn’t the top voting issue. It’s outranked by the economy and jobs, foreign policy, presidential candidates’ characteristics or positions on the issues, and immigration, according to a February Kaiser Family Foundation poll.
“Repealing the ACA is red meat for Republican primary voters,” Larry Levitt, a Kaiser senior vice president, said, “but getting any more detail than that simply puts a target on your back.”
The contenders say they want to repeal and replace the Affordable Care Act and have mentioned proposals that generally take a page from GOP health orthodoxy. But Trump’s plan includes importing prescription drugs from abroad—a staple of both Hillary Clinton’s and Bernie Sanders’s health plans. Trump has also stated that he would support allowing Medicare to negotiate drug prices—another component of the two Democrats’ plans—but his latest health proposal makes no mention of this notion.
In August, Rubio penned an op-ed in Politico titled “My Plan to Fix Health Care,” where he wrote about his commitment to repealing Obamacare and replacing it with “modern, consumer-centered reforms that lower costs, embrace innovation in healthcare, and actually increase choices and improve quality of care.” Rubio discussed three primary components of a replacement plan, ideas which are also featured on his website. His proposals include giving Americans an advanceable, refundable tax credit to buy insurance; helping those with preexisting conditions get affordable coverage; and giving states a per-capita block grant for Medicaid.
Last month, Trump tweeted his version of what health care would look like in a Trump administration: “I will replace it with private plans, health savings accounts, & allow purchasing across state lines. Maximum choice & freedom for consumer.” After criticism from last week’s debate, he released his seven-point plan Wednesday, which expounds upon his ideas.
In January, Sen. Ted Cruz came under fire in Iowa when a voter pressed the candidate on how he would replace Obamacare. Cruz hasn’t touted the release of a plan online—though he has discussed what he would do at debates. At one in February, Cruz mentioned three reforms he’d make after repeal: Allow consumers to buy insurance plans across state lines, expand health savings accounts, and break the ties between insurance and employment.
Gov. John Kasich has repeatedly defended his decision to expand Medicaid in Ohio. But he says he’s for repealing the ACA, and according to his website, he’d like to see changes that focus on “patient-centered care, choices, market competition, decentralized decision-making, higher quality, respect for individuals, and an end to Obamacare’s big government interference.”
The lack of intricate plans isn’t a new phenomenon, according to Gail Wilensky, who directed the Medicare and Medicaid programs from 1990 to 1992 and was a senior health and welfare advisor to President George H.W. Bush.
The rationale? “Republicans traditionally have focused less on health care than Democrats and thus the Republican candidates’ proposals on health care changes and reforms are unlikely to be important reasons for Republican primary voters to use to choose among various candidates,” Wilensky, now an economist and senior fellow at Project HOPE, wrote in a Milbank Quarterly article published Wednesday.
In an email Thursday, Wilensky wrote that the release of Trump’s “non-plan,” as she called it, doesn’t change matters much: “[It] just looks a little more like a program because there’s more wording and the layout—it’s the substance that’s lacking to deal with most of the uninsured that makes it a ‘non-plan.’”
Yet, some argue that candidates shouldn’t be shy on specifics, but rather bring good plans to the forefront of a campaign. “I think it would put Obamacare front and center in the way that it should be and hasn’t been,” said Jeffrey Anderson, a Hudson Institute senior fellow. “The Republican candidates ought to be telling the American people—and for now, voters—what they would do. If you want to repeal Obamacare, it’s pretty obvious you have to have an alternative.”
And if a candidate believes his or her policy is sound, Anderson said, why not get it out there?
Though the primary season so far hasn’t seen the level of fluency in health care that Anderson would like, that could change during general-election season, as a Democratic contender pressures their Republican challenger to talk about their detailed plans, and both candidates vie for independent voters.
“The contrast on health care in the general election will be quite significant,” Levitt said. “It’s always hard to predict which issues will be most prominent and most salient, but I think health care will provide an example of how the election could lead to a very different future.”
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