Wisconsin Gov. Scott Walker is jump-starting a debate on ObamaCare with the hope of getting out in front of his GOP rivals on one of the party’s toughest topics.
Walker on Tuesday became the first leading presidential candidate to put forward a detailed replacement plan for the healthcare reform law, a move that will put pressure on his rivals to release their own plans. Louisiana Gov. Bobby Jindal (R), who has trailed in the polls, is the only other candidate with a full plan, which focuses on grants to states.
“Certainly, any time a presidential candidate comes out with a real plan, it creates pressure on other campaigns to do the same. And that is a very good thing,” said Dan Holler, communications director for the conservative group Heritage Action.
Repealing ObamaCare remains a top priority for grassroots conservatives. Sen. Marco Rubio (R-Fla.) released the outline of a three-point plan but has not provided details. Other candidates have not yet made clear their positions on healthcare policy.
The GOP field reacted to Walker’s proposal cautiously, with only Jindal offering a statement.
He blasted Walker’s proposal, arguing that he is merely setting up a new entitlement program to replace ObamaCare.
“Governor Walker endorsed the fundamental underpinning of Obamacare – the notion that America needs another entitlement program,” Jindal said. “It is frankly shocking that a Republican candidate for President would author a cradle to grave plan like this.”
Shortly after unleashing criticism of Walker's plan, Jindal challenged him to a debate on the topic.
"The Governor is happy to have this discussion in person with Governor Walker. He would debate him on health care any time," spokeswoman Shannon Dirmann said.
Walker’s proposal would repeal all of ObamaCare, dismantling its federal healthcare exchanges and eliminating the tax credits now provided for people to buy health insurance policies. It would replace them with a system that doles out federal dollars based on an individual’s age, instead of income.
For example, a person between the ages of 18 and 34 would receive $1,200, while a person between the ages of 50 to 64 would receive $3,000. The tax credits would only go to people without employer-sponsored coverage.
Unlike ObamaCare, his plan would also allow groups, such as small businesses or farmers, to band together to negotiate lower rates and allow all individuals to purchase coverage across state lines.
States would also be on the hook for certain Medicaid reforms, a program which he said had absorbed most of the country’s new healthcare customers under ObamaCare. Walker promised to move away from the current “open-ended matching program,” and instead create a specific state contribution.
Most of Walker’s ideas are recycled from previous conservative proposals, but his attempt to get out in front of other candidates is a smart move politically, said Tom Miller of the conservative American Enterprise Institute.
“I’m not really surprised by anything he said, but he put it all together and he put it out first, which means other folks have to say, ‘That’s OK, and I’ll do that too,’ or they’ll have to make marginal differences from one another,” said Miller, who advised 2008 Republican presidential nominee John McCain on healthcare.
“Most of what other Republicans will say will be variations [of Walker’s plan],” Miller predicted.
Yet Jindal was not the only voice critical of Walker’s proposals, highlighting the danger of tackling healthcare policy.
Avik Roy, a prominent conservative healthcare expert who advises former Texas Gov. Rick Perry’s presidential campaign, wrote in Forbes that Walker is “largely unclear” on how to pay for his plan.
The price of the tax credits Walker is proposing, several conservatives said, could be high.
Walker declared his plan would be cost-neutral, pointing to savings from capping federal Medicaid payments to states and taxing high-cost health plans. But the Congressional Budget Office has warned that repealing ObamaCare would increase the deficit by $137 billion over 10 years.
Roy expressed doubt Walker could cover the costs.
“The point is, it’s easy to promise to expand coverage or replace Obamacare. What’s hard is paying for it in ways that are politically viable,” Roy wrote.
AshLee Strong, a Walker campaign spokeswoman, countered criticism by saying conservatives are giving the plan “rave reviews” and have supported the kind of tax credits Walker proposes.
“The refundable health care tax credits the governor includes have been supported by many conservatives because they put health care decision making in the hands of the American people where it belongs,” she said in a statement.
Indeed, most parts of Walker’s plan, dubbed the Patient Freedom Plan, are similar to other Republican healthcare proposals.
The system of age-based tax credits is similar to a 2014 plan created by Sens. Orrin Hatch (R-Utah), Richard Burr (R-N.C.) and former Sen. Tom Coburn (R-Okla.), as well as a plan from House Budget Committee Chairman Tom Price (R-Ga.).
The current law bases its tax credits on income and gives poorer people a boost.
Walker's plan "would be quite a bit more generous for higher-income people than the ACA [Affordable Care Act], but provide much less help to the poor,” said Larry Levitt, vice president at the Kaiser Family Foundation, which does nonpartisan health analysis.
Walker’s plan is also similar to other Republican plans in that it prevents discrimination against people with pre-existing health conditions when they are switching plans but not when they are looking to get coverage. To help those people, the plan would give funds to states for high-risk pools that allow people with pre-existing conditions to buy government subsidized coverage, another common Republican idea.
In contrast, ObamaCare bans discrimination based on pre-existing conditions for all people and mandates coverage to prevent anyone from waiting until they become sick to buy insurance.
The broader plan also resembles the Patient Freedom Bill drafted by Sen. Bill Cassidy (R-La.) earlier this year. Some parts, including a focus on health savings accounts and allowing people to buy coverage across state lines — are also included in Jindal’s ObamaCare replacement plan.
Yuval Levin, a National Review columnist who specializes in healthcare, praised Walker’s plan. He argued it creates through its tax credits a baseline of minimal catastrophic coverage and then allows for a market for more coverage if people want it. He said that contrasts with ObamaCare, which creates bloated plans with high out-of-pocket costs by requiring them to cover a wide range of benefits.
“I think it’s the most substantively and politically serious conservative health care reform we have yet seen from a presidential candidate, and hopefully it will spur some more to come,” Levin wrote.
This story was updated at 6:14 p.m.