In his new book, Overcoming Obamacare, Philip Klein of the Washington Examiner lays out the nuances among three different schools of thought on how best to repeal and replace or reform Obamacare.

Avik Roy, Senior Fellow at the Manhattan Institute, champions the Reform School. In his view, incrementally transcending the federal health law is the most politically feasible option. His proposal looks beyond lightening the regulatory load that Obamacare imposes on health insurers, employers, and consumers. The overarching goal is to slowly whittle away the major government health care takeover that occurred in 1965 – the passage of Medicare and Medicaid. Obamacare certainly comes with a steep price tag, but its overall cost is small potatoes compared to the total amount of government intervention in the health care industry:

governemnt takeover of healthcare 1965

 

As a means to this end, Roy seeks to progressively raise the eligibility age for Medicare and offer refundable tax credits to low and middle-income individuals (including those entitled to Medicaid) as a way to offset the cost of competing private plans on a universal exchange platform.

Roy’s proposal has sparked controversy among market-oriented health reformers because his vision holds onto some of Obamacare’s key components such as the exchange framework and using revenue from capped tax exclusions on employer-sponsored health insurance to finance tax credits for low and middle-income Americans (this is essentially the same as the law’s ‘Cadillac Tax’). However, he does inject market competition by allowing more consumers to choose private plans over government payers.