The longstanding dream of Republicans in Congress has been to kill the Affordable Care Act by letting people or states opt out of its provisions. In the years since the law’s passage, the legislative landscape has been pockmarked with “opt-out” proposals: John Barrasso and Lindsey Graham introduced a 2011 bill allowing states to duck out of the individual mandate, expanded Medicaid, and coverage mandates; John McCain backs legislation allowing individuals to escape the individual mandate and the tax penalties for not maintaining minimum coverage. Typically, Republicans are up-front about the purpose of these bills. “I’m confident that if given the chance, a large number of states would opt-out of the provisions regarding the individual mandate, employer mandate, and expansion of Medicaid,” Lindsey Graham said of his bill in 2011. “As more states opt-out, it will have the effect of repealing and replacing Obamacare.”
That wasn’t exactly true – opt-out bills are all about repealing Obamacare, and have nothing to do with replacing it. They fit into the broader pattern of the GOP being endlessly creative in their efforts to scuttle the law, but completely incapable of formulating a coherent healthcare reform proposal of their own. The renewed threat to Obamacare posed by King v. Burwell has left Republicans scrambling to finally break through five years of policy inertia and come up with a plan, and former Sen. Phil Gramm thinks he’s hit on something.
Gramm calls it, amusingly, the “freedom option.” It’s another opt-out proposal that would be put in place if the Supreme Court rules that states using federal health exchanges are ineligible for federal tax credits. As Gramm describes it in a Wall Street Journal Op-Ed, the “freedom option” would “guarantee the right of individuals and businesses to opt out of Obamacare” and purchase whatever insurance they wanted at whatever price they could get on the newly deregulated market. Sounds good, right? I mean, given the option, who wouldn’t choose “freedom”?
But as Jonathan Cohn points out, all Gramm is proposing here is allowing people to return to the pre-Obamacare days of young people buying cheap, barebones coverage while the old and sick find themselves either priced out of the market or denied coverage altogether. “Freedom” is terrific, so long as you don’t plan on getting sick or hurt.
What sets Gramm’s “freedom option” apart from other opt-out plans is the naked cynicism that motivates it. Gramm doesn’t actually care about whether people can afford insurance or providing coverage options for people with pre-existing conditions. His primary concern is helping Republicans avoid taking any political damage in the event that the Supreme Court rules against the administration in King and throws the health insurance market into complete chaos. To that end, he describes the “freedom option” as a policy that can exist alongside the Affordable Care Act and will create a happy national hybrid of two completely different health insurance markets:
Every American should have the right to decide not to participate in ObamaCare: If you like ObamaCare and its subsidies, you can keep it. If you don’t, you are free to buy the health insurance that fits your needs.
“If the freedom option were combined with a provision that allowed federal-exchange subsidies or state actions setting up state exchanges,” Gramm adds, “existing providers and recipients of subsidies would not be threatened.” This is nonsense, and Gramm knows it. The Affordable Care Act’s success is built on what’s popularly been described as the three-legged stool: the individual mandate, coverage mandates, and subsidies. Kick out one leg, and the whole thing collapses. Gramm wants to give people the option to kick out all three legs at once. The ACA can’t survive under those conditions, and he acknowledges as much later in the piece: “the freedom option would put ObamaCare on the path to extinction.”
So what he’s advocating here is a strategy to trick people into believing they’re being given the “freedom” to pursue health coverage however they see fit, when in reality they’re being slowly railroaded into the pre-Obamacare hell of arbitrarily high premiums, discrimination based on pre-existing conditions, ballooning uninsurance rates, uncompensated emergency room care, and the like. And then, only after Obamacare has died, the GOP will finally come forward with their long-promised magical healthcare reform plan that will lower costs, boost coverage, cost nothing, and regulate no one.
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