DAVID GREENE, HOST:
Here at home, President Obama has repeatedly criticized House Republicans for voting to repeal his health care law without offering a replacement.
PRESIDENT BARACK OBAMA: They have no alternative answer for millions of Americans with pre-existing conditions who'd be denied coverage again.
GREENE: Republicans have promised an alternative but have yet to release it. And that left one Republican lawmakers on the defensive during a town hall meeting in Florida.
Here's NPR's Scott Horsley.
SCOTT HORSLEY, BYLINE: Florida Congressman Dennis Ross was talking to constituents in Tampa this month when a man stood up in the back of the room and asked why House Republicans are so determined to repeal Obamacare without offering a plan to replace it. In an exchange recorded by Think Progress, Ross acknowledged that's a shortcoming for the GOP.
REPRESENTATIVE DENNIS ROSS: And let me tell you, I think one of the most unfortunate things that my party did the last three years was not offer an alternative to healthcare.
HORSLEY: Of course, some have argued Obamacare itself is a conservative alternative modeled on a plan that GOP lawmakers offered back in the 1990s in response to Bill Clinton's healthcare plan and later adopted by Republican Mitt Romney in Massachusetts. Tom Miller of the American Enterprise Institute, however, insists other conservatives have always rejected that plan, especially the requirement that every American obtain health insurance.
TOM MILLER: We're not in favor of trying to compel people to buy products they don't want to buy.
HORSLEY: That mandate is one of the most controversial parts of Obamacare. If you take it away, though, you also have to give up one of the law's most popular features, the requirement that insurance companies offer coverage to everyone. Otherwise people could simply wait until they get sick and then sign up.
Avik Roy of the conservative Manhattan Institute says there are other ways to guarantee coverage for people with preexisting medical conditions.
AVIK ROY: An alternative approach that Republicans talk about a lot is what's called high-risk pools, where you offer to people who have preexisting conditions coverage in that way and the insurance product is subsidized by taxpayers.
HORSLEY: Before Obamacare, many states did operate limited high risk pools. Supporters say scaling those up to cover everyone with a preexisting condition could cost taxpayers $20 billion a year, though that's still less than the subsides in Obamacare. Conservatives also favor whittling away at the tax advantage now given to employer-sponsored health insurance.
AEI's Miller says that would put self-employed workers on more equal footing, make it easier for people to change jobs without losing coverage, and reduce the incentive to buy more insurance than you need.
MILLER: You don't want to create a lot of instability in the existing employer-based system overnight, but the goal should ultimately be to say that we're not going to treat different purchases of healthcare differently.
HORSLEY: Obamacare itself takes some baby steps in that direction, but conservatives have generally been more willing to disrupt the workplace coverage that most Americans now rely on. Conservatives have also been more aggressive in proposing changes to Medicare and Medicaid. Avik Roy suggests gradually shifting future retirees off Medicare and into an Obamacare-style marketplace where they could buy their own insurance with federal subsidies only for the needy.
ROY: It would save a lot of money by transitioning wealthy retirees out of the existing system and it would devote some of that savings to improving the quality of coverage for low income people.
STEVE INSKEEP, HOST:
But for all the ideas floating around conservative think tanks, Republicans in Congress have yet to rally around a plan to replace Obamacare. In part, that reflects political expedience. With opposition already dogging the president's plan and boosting the GOP's chances in the next election, why should the party invite attack by putting up a plan of its own?
HORSLEY: What's more, Roy says fixing the problems in the U.S. healthcare system has never been a top priority for the GOP.
ROY: Who's the typical Republican voter? It's someone who's older or someone who's employed, and we spend $1.2 trillion a year subsidizing health coverage for retirees and employed people, so the Republican voter benefitted from the pre-Obamacare arrangement.
HORSLEY: Tinkering with that arrangement is part of what made Obamacare so controversial all along. With each passing month, though, the Affordable Care Act becomes more entrenched, putting more pressure on Republicans to justify a change and to spell out just what a different healthcare system might look like. Scott Horsley, NPR News, Washington.
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