The Affordable Care Act Is Not Remotely Similar to the Heritage Plan

As long-time readers know and new readers were reminded yesterday, I’ve long been intensely irritated by claims that the Affordable Care Act proves that Barack Obama is a hapless sellout because it was a “Republican plan.” The rather obvious problem with this line of argument is that any non-trivial number of Republicans have been willing to support the “Republican plan” when 1)massive veto-proof supermajorities of liberal Democrats put it on their desk, and 2)that’s it. Republican support for the plan might discredit it if any conservative Republicans ever wanted anything like it to pass, but of course they didn’t. The plan was a decoy, not a “Republican Plan,” so which think tank came up with it is neither here nor there.

But as stepped pryamids points out in comments, I’ve really been burying the lede. While aware that the Heritage Foundation plan was inferior, I’ve played along with the idea that the ACA was in some way comparable to the Heritage plan. But in fact, the two plans are not remotely comparable. Actually reading the famous policy document, it’s striking how little of relevance the plans have in common. Yes, both plans have a mandate, but since any means of comprehensive insurance that didn’t involve eliminating the health care industry was going to have some kind of mandate to prevent a death spiral in the insurance market, so in itself that doesn’t mean much. And this is a major issue, because that’s where the similarities end. As s.p. puts it:

The Heritage plan was an individual mandate for catastrophic coverage with a tax credit to help subsidize it. That’s pretty much it.

[…]

It’s like saying the EITC is a Republican plan because the Republicans proposed capital gains tax cuts and they’re both tax cuts.

And the Heritage plan is actually even worse than that. Where the ACA included a massive expansion of Medicaid, the Heritage plan essentially proposes to apply the principles of welfare “reform” to Medicaid, allowing states more “flexibility” (to reduce coverage) and allegedly helping the poor by eliminating state regulations requiring health insurance to have actual content. (In fairness, it does offer to give tax benefits to people who subsidize the health care of poorer relatives, so the many poor Americans with rich uncles will be in great shape!) It would have taxed health care benefits gained through employment as income, and therefore for all intents and purposes forced middle-class people into an individual market that for the non-wealthy would have offered nothing but crappy, largely unregulated catastrophic coverage. Oh, and it would have voucherized Medicare a la Paul Ryan.

To compare the ACA and the Heritage plan, in other words, is ludicrous. The ACA contains many long-standing liberal priorities — expanding Medicaid, regulating the health care industry, providing substantial subsidies for real insurance — that the Heritage plan manifestly does not. And the Heritage plan includes many horrible ideas that the ACA did not contain. But acknowledging the massive, fundamental differences between the ACA and the Potemkin Heritage plan — differences of kind, not of degree — makes it harder to advance the narrative that the flaws in the ACA result from Barack Obama’s abiding hatred of the very idea of federal intervention into the health care market. If Obama had actually proposed something like the Heritage plan, it would actually be fair to call him a neoliberal stooge. But he didn’t, and the differences between the Heritage plan and the ACA disprove the charge conclusively.