http://www.modernhealthcare.com/article/20160113/blog/160119943

Some liberal healthcare policy experts are urging an ambitious, costly program to expand and improve the Affordable Care Act’s coverage. Meanwhile, conservative policy mavens are promoting an even more ambitious ACA replacement packagethey say would reduce the uninsured rate and lower healthcare spending with less government intervention.

Falling in between, the centrist Bipartisan Policy Center recommended last month that the Obama administration meet with governors to advance new health insurance approaches, including flexible use of the ACA’s Section 1332 state innovation waivers allowing implementation of alternative coverage models.

These proposals represent efforts from the left, right and center to frame the health policy options for the next president and Congress following the November elections. Indeed, Democratic presidential candidate Hillary Clinton has proposed measures similar to those offered by the liberal reformers to make healthcare more affordable, while Republican hopefuls Jeb Bush, Marco Rubio and Chris Christie have borrowed ideas from the conservative experts.

“The smart players realize this isn’t a healthcare election,” said Lawrence Jacobs, a political science professor at the University of Minnesota who studies healthcare politics. “But that doesn’t mean you’re not active preparing the ground for post-election discussions.”

The authors, including Joseph Antos of the American Enterprise Institute, James Capretta of the Ethics and Public Policy Center, and Gail Wilensky of Project Hope, acknowledged the political and policy difficulties in implementing these changes. “The depth and breadth of the reforms listed here are not likely to be accomplished and perhaps not even attempted in a single presidential term,” they wrote.

Republicans have been sharply criticized for failing to present their own reform plan. They are hobbled by sharp differences between various factions of the party. Some favor a comprehensive plan with tax subsidies to help people afford coverage, similar to the conservative policy experts’ proposal described above. Others prefer a much more limited approach featuring Republican standbys such as limits on medical malpractice lawsuits, allowing insurers to sell plans across state lines, letting employers band together to buy insurance, and greater reliance on health savings accounts.

Despite the prodding from liberal and conservative reformers, the University of Minnesota’s Jacobs predicts that neither Republican nor Democratic candidates will offer detailed healthcare proposals during this year’s election campaign. The Democrats will avoid it because they don’t want to open themselves to criticism about more costs and regulation. Their message is “consolidation and bite-size improvements” in the ACA. Meanwhile, he said, Republicans don’t want to discuss specific plans with features that may resemble Obamacare and would alienate their political base.

After the election, even if the Republicans win the White House, “reality is staring them in the face, the world has changed, and going back (to the pre-Obamacare system) is not an option,” Jacobs said. Depending on the size of their victory, they may ratchet down premium subsidies and convert Medicaid into a state block grant program. But given healthcare industry and public support for many key ACA features, he predicted Republicans largely would be “relabeling aspects of Obamacare.”