From "repeal and replace" to "retain and improve"

"Repeal and replace" has been the mantra of Affordable Care Act/ObamaCare opponents almost since ObamaCare.  Although the "repeal" part has been tried many times in the House, very little serious attention has been paid to the "replace" part. The recent proposal by Republican Senators Orrin Hatch, Tom Coburn and Richard Burr is still couched in "repeal and replace" terms, but the actual contents of The Patient Choice, Affordability, Responsibility, and Empowerment Act are best described as an effort to retain much of ObamaCare --including changes to Medicare, bans on insurance coverage caps, coverage for children up to age 26 and so on.There are all sorts of things in this proposal that I don't like, but in the interest of spurring constructive dialogue to actually improve the Affordable Care Act I will highlight a couple of provisions that I think are improvements.The first one  is in Title 2, Section 201, which calls for allowing insurers to charge older people up to 5x what they charge younger people.The second is Title 6, Section 601, which "caps the tax exclusion for employee's health coverage at 65 percent of an average plan's costs." In other words, it limits the size of the tax deduction for employer-provided health insurance.To reinforce my "retain and improve" label, keep in mind that both of these provisions are essentially tweaks to the ACA. The ACA limits insurers to charging 3x the premium for older v. younger people and the so-called "Cadillac Tax" also limits the deductibility of expensive plans.In any case, here why I like these two provisions:

• Older people already get a very good deal from the government. Medicare represents a significant transfer from the working age population to those who are older. While it's true that people pay into Medicare while working, the amount they pay comes nowhere near the actual costs of the program. It's a cruel irony that there are many taxpayers without health insurance who pay taxes that subsidize older people on Medicare. The Affordable Care Act exacerbates the transfer from young to old by effectively making younger people overpay for insurance and giving older people a subsidy. The Republican proposal improves intergenerational equity and also helps stabilize the insurance market by bringing the ratio into line with the actual difference in cost.
• Providing a tax deduction for health insurance provides an incentive to spend more on health insurance and less on wages. It also represents an unfair advantage for those who get insurance through their work rather than on the individual market. I'm in favor of phasing out the deduction completely over time. This proposal from the GOP does a better job than ObamaCare of reducing the deduction

What do you think? Do you agree with the "retain and improve" label? Are there other things you like about the new proposal? Leave a comment on the blog or Twitter @HealthBizBlogphoto credit: katerkate via photopin cc---By David E. Williams of the Health Business Group