Why the Patient CARE Act proposal is 'going to need a bigger boat'


Article Highlights

  • Burr-Coburn-Hatch Patient CARE Act proposal has promising elements but ultimately falls short.

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  • Hill Republicans are starting to propose credible health reform alternatives but need to think outside usual boxes.

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Key points in this Outlook:

  • Republicans on Capitol Hill are beginning to shift their focus from simply repealing Obamacare to proposing credible alternatives for health reform.
  • The Patient CARE Act proposal from Senators Burr, Coburn, and Hatch has some promising but underdeveloped elements that ultimately fall short of what is needed to effectively accomplish meaningful reform.
  • A more comprehensive vision for replacing Obamacare will need to build a better pathway toward improved health outcomes and sustainable prosperity for more Americans.


The new strategy for Capitol Hill Republicans in 2014 appears to involve finally offering early versions of a health reform plan to replace and not just repeal the Affordable Care Act (ACA), which launched “Obamacare” almost four years ago. Since then, dozens of legislative, judicial, and political efforts to stop the health law and its regulatory spawn have highlighted Obamacare’s multiple product defects. Those activities have helped to solidify the ACA’s broad unpopularity among voters, but rocky implementation of the law continues to stagger ahead. Prospects for complete repeal alone seem increasingly dimmer. The apparent missing ingredient has been a credible alternative to address long-standing policy problems in our complex health system.

Hence, the recent shift by Hill Republicans to begin providing the outlines of their own policy recommendations is long overdue. This type of legislative effort is not generally within the comfort zone of most Obamacare opponents, particularly incumbent politicians. Indeed, linking the words “Hill Republicans” to the phrase “health care reform plans” for many decades has been akin to Samuel Johnson’s classic comment on a dog walking on his hind legs: “It is not done well; but you are surprised to find it done at all.”[1]

Although a number of limited legislative health reform proposals have circulated in recent years, they usually have lacked the comprehensive scope, strategic vision, attention to implementation obstacles, or support by key leaders to present an effective and attractive replacement alternative to the floundering ACA regime. Stepping up to try to fill this vacuum is the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act, proposed in late January by Senators Richard Burr (R-NC), Tom Coburn (R-OK), and Orrin Hatch (R-UT).

The three veteran lawmakers are experienced in the intricacies of health policy, grounded in conservative principles, and committed to overturning the most dangerous aspects of Obamacare. The Patient CARE Act’s stated policy objectives are to lower health care costs, put patients in charge of their health decisions, provide relief from Obamacare’s mandates, and ensure affordable health care for patients and taxpayers.[2] However, it also represents the draft outline of a political document that aims primarily to fill in enough blanks for a Republican alternative to maximize support for replacing as much of the ACA as possible.

Unfortunately, the initial Burr-Coburn-Hatch proposal primarily reveals the limits of most conservative health policy thinking and the bounds of conventional politics. It thus falls short of what is needed to reverse the downward drift of our overregulated, oversubsidized, and overpoliticized health care system.


1.  “Women Preaching . . . / Dog Walking . . . ,” The Samuel Johnson Sound Bite Page, www.samueljohnson.com/dogwalk.html.
2. The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act: A Legislative Proposal, section 101, 1, www.hatch.senate.gov/public/_cache/files/bf0c9823-29c7-4078-b8af-aa9a12213eca/The%20Patient%20CARE%20Act%20-%20LEGISLATIVE%20PROPOSAL.pdf.

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