Earlier this week, Florida Senator Marco Rubio tossed into the Republican presidential campaign ring an abbreviated version of his plan to fix health care. How does his approach (published in Politico magazine) compare to a somewhat more detailed plan released by Wisconsin Governor Scott Walker the next day?
Republican presidential candidate and U.S. Senator Marco Rubio speaks at a campaign stop in Cleveland, Ohio August 5, 2015. REUTERS/Aaron Josefczyk.
Both candidates for the Republican nomination agree on several core concepts:
(1) Creating refundable tax credits to help more Americans purchase health insurance;
(2) Reforming insurance regulation through such mechanisms as high-risk pools, expansion of Health Savings Accounts, and enabling the purchase of coverage across state lines; and
(3) Moving Medicaid financing into a block grant system with more state flexibility.
These are all pretty standard Republican policy touchstones.
However, Rubio again engaged Medicare (at least briefly), in terms of endorsing a premium-support-style reform of the program for future beneficiaries. Exactly how soon, and at what speed, remains unspecified for now. Walker’s team plans to address that issue at a later date.
Reading between the lines of the respective plans, there may be some differences in their respective approaches to tax policy for health insurance. Rubio sets a more aggressive long-term goal of equalizing tax subsidies, regardless of whether one gets insurance through an employer or buys it more directly as an individual. Walker more cautiously and ambiguously extends new age-based tax credits to individuals without access to an offer of employer-based insurance. Rubio’s approach looks over the next election’s horizon toward a more consumer-driven health care marketplace operating on a level playing field. How he would get there — in terms of reducing the generosity of the current tax exclusion without disrupting employer-based coverage too drastically, while specifying just how generous the refundable tax credits would be — is a challenge he has not yet addressed. (That’s the difference between an aspirational op ed and a more detailed legislative plan that could be assessed in more practical terms.)
The Walker plan is somewhat more nuanced in its approach to block-grant financing reform of Medicaid, as it distinguishes among different components of the federal/state program and declining to cap funding for acute care for the disabled and low-income elderly. Rubio’s broader “per-capita” framework for block grant delegation of federal funds to the states potentially could be far-reaching, but he hasn’t said enough about it to indicate where his programmatic boundary lines begin and end.
Rubio’s plan also reinforces his firm opposition to taxpayer-funded risk corridor subsidies for insurers participating in Obamacare’s health exchanges. He notes that, aside from his plan’s three core components of tax credits, insurance regulation reform, and fiscally-sustainable reform of Medicaid and Medicare, “other measures may be necessary to undo the damage done by ObamaCare.”
The Florida senator has composed the opening theme music of health policy reform for Republican presidential primary voters. Walker adds more of the lyrics of programmatic change. But the final version of the Republican presidential show will need more casting tryouts, a few more script doctors, and tryouts across the county — before it’s ready to open in Cleveland later next year; let alone the November 2016 election. (I hear “it’s gonna’ be huge!”)
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