Finally, House GOP unveils draft of its healthcare bill

After months of waiting, Republicans debut their reform plan -- but is it anything more than a political move?


Alex Koppelman
November 4, 2009 12:25AM (UTC)

It's finally happened: After months of waiting and assuring voters that they had a plan, despite having no single proposal supported by their leadership, House Republicans have released a draft (PDF here) of their very own healthcare reform bill.

Naturally, the legislation is significantly different from the Democrats' proposals. There is, of course, no public option -- there's also no health insurance exchange, which would allow small businesses and individuals to pool together to buy coverage, no ban on insurance companies rejecting people because of pre-existing conditions, no individual mandate.

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There is, however, a short list of ideas that have been bouncing around the right for some time, like tort reform that would cap the punitive awards in malpractice cases at $250,000, like allowing insurers to sell across state lines and like an expansion of the high-risk pools offered by states.

There will, no doubt, be some analysis of the bill down the line, though perhaps not all that much. That's because the most important thing to remember abut this bill is that the GOP knows it will never pass. Writing a bill you know has not a snowball's chance in hell is a very different process than one that might actually become law. In this case, the Republicans had very different objectives for this bill than the Democrats did. The Republicans wanted to keep the bill short -- they've been attacking their opponents for writing bills that top out at around 1,500 pages -- they wanted to keep the cost low, and they wanted to have something they could hang their hat on. Whether it would work, or even make sense, is at best a secondary priority.

Need proof? Look at the goals laid out at the beginning of the bill:

(b) PURPOSE.—The purpose of this Act is to take meaningful steps to lower health care costs and increase access to health insurance coverage (especially for individuals with preexisting conditions) without—
(1) raising taxes;
(2) cutting Medicare benefits for seniors;
(3) adding to the national deficit;
(4) intervening in the doctor-patient relationship; or
(5) instituting a government takeover of health care.

For another good example of how this dynamic plays out, take a look at the first major provision in the bill, one which mandates that states set up pools to provide coverage for high-risk individuals. As Time's Karen Tumulty points out, "These pools already exist in more than 30 states, but they tend to be too expensive for those with limited means to buy into. And often, people cannot get into them for as long as a year after they apply." The GOP bill would bring the cost for those pools down to 150 percent of "the average premium for applicable standard risk rates in that State," and force the states to end those waiting periods. That would still be prohibitively expensive for many, though, especially because the only option the states would have to offer -- they're forced to provide two, but the other is up to them -- is a high-deductible plan. That is, high premium and high deductible.

Where you really see the problems that come in when the bill doesn't have to work, though, is in the funding provided for these pools. The bill appropriates just $15 billion over 10 years, to be divided up among all 50 states. That works out to about $30 million per state, per year. Just the administrative costs can be expected to take a sizable chunk out of that money, which really amounts to pocket change anyway.

But as part of the same provision about high-risk pools, the GOP did include language that would specifically exclude anyone who's not a U.S. citizen or national -- if you'll remember from the infamous "You lie!" incident involving President Obama and Rep. Joe Wilson, R-S.C., that's been a political issue already.

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Update: One more point worth making, along the lines of what I've been saying. The GOP bill does not include something other Republican proposals had featured, and that you'd normally expect from the party: Tax cuts. Why? Well, reportedly because House Minority Leader John Boehner determined they'd be too expensive. That's a pretty good reason, especially when what you're proposing is essentially a show bill. Tax cuts woudl drive up the cost of the bill pretty fast, thus diminishing the effectiveness of a key Republican talking point.


Alex Koppelman

Alex Koppelman is a staff writer for Salon.

MORE FROM Alex Koppelman

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Healthcare Reform John Boehner, R-ohio Republican Party War Room




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