Obamacare: What would Reagan do?

Henry Olsen, master election analyst and a scholar of Ronald Reagan, asks what position Reagan would take in the Obamacare debate. Olsen concludes that The Gipper would (and did) back government-subsidized medical care for people who couldn’t otherwise afford it and would approve of federal subsidies such as those contained in Obamacare.

Olsen bases these conclusions mainly on Reagan’s support for the Kerr Mills Act. Enacted in the pre-Medicare era, this legislation provided federal funds to states to set up programs to pay for medical care for poor senior citizens. Olsen also cites Reagan’s refusal, as governor of California, to repeal the state’s participation in Medicaid.

This demonstrates that, in very different times, Reagan supported certain kinds of subsidies for people who can’t afford health care. But it doesn’t show that Reagan would back Obamacare subsidies or GOP replacement proposals that don’t really repeal them.

Reagan’s support for Kerr-Mills occurred in the pre-Medicare era. His support for California’s participation in Medicaid occurred in the pre-Obamacare expansion era.

By the time Obama was elected president, Medicare and Medicaid provided subsidized insurance for those who need it the most. Obamacare then expanded Medicaid to subsidize insurance for a less needy group. I doubt that Reagan would have supported forcing states to expand Medicaid, as Obamacare was intended to do.

Would Reagan support the present scheme that allows states to opt out of the Medicaid expansion? Possibly. My guess — far less educated than Olsen’s — is that, Reagan would instead support market-based efforts to reduce the cost of health insurance.

What about subsidies to pay for a portion of the health insurance premiums for people who earn too much to qualify for even the expanded version of Medicaid? It’s hard for me to imagine Reagan backing this.

Olsen concludes:

If [Reagan] were convinced, as Senate bill critics argue, that this bill’s Medicaid changes will keep people from getting the care they need, Reagan would surely have worked to find a solution.

I agree. However, I think that, for Reagan, the solution would be market-based, with a focus on eliminating one-size-fits-all federal regulations (something Reagan consistently opposed, as Olsen notes). I also think Reagan would be happy to support a “work” requirement for able-bodied Medicaid recipients.

Reagan opposed passage of both Medicare and Medicaid. He surely would have opposed Obamacare, as every Republican Senator, including Susan Collins and Olympia Snowe, did. Thus, it’s difficult for me to imagine Reagan backing any Obamacare replacement bill that doesn’t radically overhaul it.

Thus, if Reagan opposed the Senate replacement bill — which I think is likely — he probably would have opposed it based more on the complaints of Sens. Lee, Cruz, Paul, and Johnson than on the concerns of Sens. Collins and Heller.

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