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opinion | Nathaniel P. Morris

GOP gets serious on health care

Senator Tom Coburn from Oklahoma.

AP/file 2013

Senator Tom Coburn from Oklahoma.

January was a busy month for Tom Coburn, the junior senator from Oklahoma.

Though known for his staunch conservatism, he started off the New Year by introducing a bipartisan bill with Senator Elizabeth Warren of Massachusetts — the pair hopes to improve the transparency of federal agency settlements with corporations.

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Soon after, Coburn shook the electoral landscape by announcing his intention to step down from his seat at the end of the year. As media outlets began assessing his legacy and scrutinizing potential replacements, he kept on working. In the week before the Super Bowl, he and Senator Angus King of Maine joined forces to revoke the tax-exempt status of certain wealthy organizations in professional sports.

But, of all of Coburn’s endeavors last month, proposing health care legislation that was widely received as the most viable Republican alternative to Obamacare was one of his most important. He is indeed a medical doctor and one of the Affordable Care Act’s most vocal opponents.

On Jan. 27, Coburn, along with Senators Richard Burr of North Carolina and Orrin Hatch of Utah, unveiled the Patient Choice, Affordability, Responsibility, and Empowerment Act. The plan, dubbed the Patient CARE Act, provides a welcome opportunity to explore Republican suggestions for American health policy. For the last four years, the GOP platform has rested on the promise to “repeal and replace Obamacare.” However, by now, most people would agree Republicans have focused too obsessively on the former.

So, what’s in the proposal?

Its first section is unsurprising: repeal the Affordable Care Act. Yet, the blueprint goes on to reinstate popular elements of the law, such as guaranteed plan renewability, an end to lifetime payout limits, and dependent coverage until age 26.

While undergoing chemotherapy, Oklahoma’s Tom Coburn brings some productive ideas to the debate.

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From there, Coburn and his colleagues have laid out a number of largely market-oriented approaches in hopes of decreasing costs and increasing consumer choices.

The draft hinges on a series of refundable tax credits for people earning below 300 percent of the federal poverty level to buy health insurance. Obamacare has a similar design, but more generously draws the line at 400 percent. Both approaches cover some of the costs of the subsidies through more efficient Medicare spending — the provision portrayed as a “Medicare cut” by many Republicans in the 2012 election. To fund remaining outlays, Coburn et al. would replace the law’s taxes on medical devices, pharmaceutical companies, and wealthy Americans with a cap on tax breaks for employer-based health coverage at 65 percent.

As the argument goes, it’s not really raising taxes, if you’re closing loopholes.

Medicaid would get scaled back, with quite a few changes. Eligible individuals could take the federal subsidies to purchase their own insurance rather than rely on the program. In addition, states would receive capped “health grants” based on the number of recipients. The theory is that per-capita funding with fewer strings attached would allow states to better tailor Medicaid services to their respective populations.

The Patient CARE Act would lessen several regulations. For example, most minimum requirements for offering a health plan would disappear. Preexisting condition protections would only apply to consumers who remain continuously enrolled from one plan to the next.

However, the legislation would introduce new oversight in various ways. The senators aim to establish an Office of Health Financing in the Treasury Department to supervise the allocation of insurance subsidies. Hospitals participating in Medicare would have to disclose payment and charity care information. And the proposal would explore an assortment of malpractice reforms to curb defensive medicine.

Predictably, the plan has garnered mixed reviews. According to Joseph Rago, an editorial board member at The Wall Street Journal, the act signifies “important intellectual progress.” Avik Roy, an editor at Forbes, called it a “serious, constructive, and pragmatic” approach. Meanwhile, The New York Times referred to the proposal as “costly and disruptive,” an “inferior version” to the Affordable Care Act. The Washington Post argued that the plan is a starting point that “falls short.”

Despite these differences of opinion, everyone has come together on one fact — because of today’s political environment, this legislation has no chance of passing soon. But the Patient CARE Act has enough in common with Obamacare that Coburn and his colleagues seem to have expanded the room for agreement.

Throughout his time in Congress, Coburn has been a polarizing figure on everything from abortion rights to climate change. His extreme views, such as his claim that a gay “agenda is the greatest threat to our freedom we face,” can be offensive and off-putting to many people.

Still, his health care proposal — whatever its merits — marks a step away from the politics of division and toward the politics of discussion. It’s notable that, during his busy January, Coburn was undergoing chemotherapy for a recurrence of prostate cancer. He’s already survived prior diagnoses of colon cancer and melanoma.

His personal and public struggles with health care are hard to dismiss. Amid tough circumstances, Senator Coburn deserves a nod for bringing productive ideas to the debate.

Nathaniel P. Morris is a student at Harvard Medical School.
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