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The three R’Amigos’ health reform plan – why it matters, why it doesn’t

Posted by John McDonough  January 30, 2014 09:05 PM

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A reasonable amount of attention is going to the new health reform proposal released this week by three leading Senate Republicans: Utah's Orrin Hatch, Oklahoma's Tom Coburn, and North Carolina's Richard Burr. Rather than get into the details, already done in many places (here, here, here), let's consider the politics of the plan. I think it is unimportant for reasons some folks suggest, and it is highly important for an alternative reason.CoburnObama.jpg

First, a tale. When I worked in the U.S. Senate in 2009, Senator Coburn (pictured, left, with his friend, the President) sat on the HELP Committee in which I worked. He had worked diligently to write his own comprehensive health reform plan, and he loved talking about it. He would bring a copy to hearings, to markups, to the Senate floor. He would hold it up, telling anyone who would listen that he had a commonsense plan we should all adopt. And he would get a fair amount of press whenever the parties got into an argument about the lack of an alternative Republican plan.

One time, I decided to check how many members of the 40-member Republican caucus had signed onto Senator Coburn's bill. It wasn't hard. He had seven, (7), [VII] co-sponsors. Counting himself, only one of five Republicans liked his bill enough to add their own names. But he just kept on touting his reform bill, and in spite of the teensy support, he seemed to get value from the exercise.

This time, Coburn is joined by two respected Senate Republicans from the get-to. Much better, especially because Sen. Hatch is in line to become Chairman of the Senate Finance Committee if Republicans retake the Senate this November. If Sen. Hatch asks for co-sponsors, he can be sure of politeful attention. None of the three is up for re-election in 2014, and Coburn has already announced his retirement at the end of this year. It will be interesting to see how many Senate Republicans sign on, and especially if any Republican running in a contested race this year is willing to sign on.

The most risky part of the proposal would tax 35% of the value of employer sponsored insurance, a guaranteed premium increase for every American who gets health insurance through his or her job. Zeke Emanuel estimates the average per person hit at $1470. Just about every organized group in American society opposes the idea except for economists, and they are not a large voting bloc.

The bill never will see the light of day in the Senate unless the Rs take control, and not clear in that case either. No vote in 2014 for sure. Had this bill been filed in 2009 as a Republican alternative, it would have merited serious attention and might have formed the basis for real negotiation. Too much water under the bridge now for this to be taken seriously by Democrats.

The Rs don't control the Senate and can't expect a vote. The House has no such excuse, though it's hard to imagine such a bill moving in that branch where every Member is up for re-election. Every Republican House Member facing a contested race and who supports this proposal (the $1470) is guaranteed to face relentless negative advertising based on their support. House Majority Leader Eric Cantor said today he expects the House will vote on a new health reform plan in 2014; he also said that at the beginning of 2013 and had to withdraw his own legislation for lack of support. It will be interesting to see what's changed in the House.

No Democrat, House or Senate, is likely to support this plan at this point. If Republicans take the Senate and hold the House, assuming it would pass, Obama would certainly veto, and there is no chance the veto would be overridden.  And, by the way, Dems might be hesitant to sign onto a politically dangerous proposal with Republicans because the last time they did that -- the individual mandate in 2009 -- the Republicans deserted their own proposal, which they had supported for at least 15 years, the moment the going got tough. Some partners!

So, this proposal has nowhere to go unless Republicans control the White House, Senate and House in 2017. Remembering how Sen. Barack Obama weakened Sen. John McCain by attacking the Arizona Senator's plan to tax employer provided health insurance, I wouldn't hold my breath for that either.

So why do this? Why does this proposal matter? Here's why:

After January 1, 2014, when health reform became real and no longer hypothetical, millions of Americans are now obtaining badly needed and desired health insurance.  It is no longer sufficient for Republicans to oppose Obamacare, and support nothing else. Three leading Republican wise-men now think straight opposition will no longer do, is no longer viable.

This is an early sign that the politics of health reform is shifting now, right under our feet.

The three R'Amigos have not invented the solution. They have invented one solution, and more will follow. Republican interest in alternative health reform proposals is about to experience a big resurgence, as the politics of health reform and the Affordable Care Act begin a fundamental shift.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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