OK, I'm going to take my lumps here, but I think that Cruz's idea - i.e., of essentially having a system of fully-ObamaRomneyHeritageCare-compliant plans along with an alternative system of not-so-fully-ORHC-compliant plans has some merit and is worthy of investigation. Now this doesn't mean that his single paragraph of anything goes is proper, far from it - but it does mean that, in light of the political realities and the fact that the current OHRC plans do not allow for any "patient-centered" efficiency (i.e., at least past the not-all-that-high deductible for even the lowest level of plans). Now, this is something that cannot possibly be worked out in a short period of time, but rather needs to go through the full committee process tp get something that can tightly work around the cuyrrent ORHC framework.
So what I am talking about here? I not talking about any change to the ORHC-compliant plans, nor am I talking about removing the Medicaid expansion or changing the premium tax credit for regular ORHC plans, at least for incomes up to some level - although whether that level has to be 400% of poverty or something higher or lower (but definitely no lower than 250% as the cost-sharing-reductions exist up to that) is up for debate.
What I am saying is that there should be a discussion about having an alternative set of rules for a system of plans that can be an option for subscribers. This alternative set of plans would be tailored to give folks who don't derive any benefit from the subsidies - e.g., like the folks that The Man From Hope said were really hitting it, working 60 hours a week, but getting crushed. These are the folks who have a certain level of legitimacy in their gripe about ORHC; now, most of the gripes deal with the fact that their pre-ORHC were junk in some way, including having a lifetime cap, and the fact that they were very healthy, so the actuarial rating of these plans was a lot lower than for ORHC plans. Other gripes are that a subscriber is a man and he doesn't want to pay for women's problems or vice-versa, or that they don't want abortion coverage, which obviously is a "fighting words" issue for a lot of folks. The alternative set of plans needs to address these gripes so that the political rhetoric gets toned down - which is in the best of interest of us who want the public not distracted with those issues, but rather engaged in the real core issues of access and subsidation.
The 0th plank is end the mandates. The current mandate is not all that fierce, and it's the main political albatross. Lower-income folks, because of the subsidies, will continue to choose to purchase ORHC plans. Perhaps even make subsidies even better to make it a no-brainer for all lower-income folks. The individual mandate, which is broadly unpopular, is really only a benefit to upper-income folks who are sick (and let's face it, most upper-income self-employed folks who get sick tend to become lower-income folks while sick!), since lower-income folks would be shielded from the effect of poor-risk-pool plans.
The 1st plank is that at some super-high level of any legitimate health-care spending - e.g., $50K or $100K or whatever, everyone is to be allowed to use Medicaid for the remainder of the year (or perhaps into the next year if the condition continues, etc.) Even the super-free-market think tank yahoos think that this type of super-catastrophic coverage should be completely socialized, paid for by the general federal fund. For folks in ORHC plans, the actuarial value of this top-level coverage would be distributed to the insurers to make their plans less expensive. (NOTE how this helps to subsidize the ORHC plans while doing what those yahoos say need to be done!) The insurers would love this too. WIN-WIN
The 2nd plank is that above some level of poverty (e.g., 400% or 300% or wherever), the expected contribution level (i.e., that sets the maximum amount of the premium tax credit) for the benchmark plan should continue on, but at a much higher rate (e.g., 25% of marginal income?) so that anyone can choose to get a fully ORHC-compliant plan, even the proverbial Bill Gates, and without a cliff. This will be the new "guaranteed issue" for upper-income folks to be able to buy a regular ORHC plan. This essentially gives the folks who lose out due to the 0th plank a way to stay in the ballgame, although at a higher cost, which frankly I am all that concerned about since these are the folks that don't like the idea of Medicare-For-All because SOCIALISM.
The 3rd plank is that whatever type of plans the free-market yahoos can think about will be vetted through a thorough review process in the committees. There will need to be only certain types of plans that any alternative plan must follow (call it "flavors" of plans). A very simple flavor could be a complete non-plan in which the 1st plank takes care of the super-high end, and the subscriber is like a buyer at a Turkish bazaar negotiating everything; I think for this flavor plan, to make sure that the subscriber doesn't go EMTALA (and the Republicans will be in line on this, as they are the party of "personal responsibility"), the subscriber needs to have the deductible in some type of escrow (this could be their "health savings accounts") or would need to buy some type of financial bond that guarantee payment of the services in the deductible. And there could be other flavors that the free-marketeers could think of; so long as they are vetted, there shouldn't be a problem.
The 4th plank is to incorporate any sensible reforms that would help to make the 3rd plank plans more desirable (but which would make ALL plans better as well) - e.g., getting rid of the "coverage gap" (i.e., folks under poverty not getting a premium tax credit that are stuck without Medicaid because their governor is a jackass) and "family glitch"; forcing ALL providers to post prices (which really is essential for the 3rd plank plans to succees); doing something about Rx, be it reimportation or what Louisiana's Rebecca Gee is advocating, just something to rein in these crooks; and of course, allowing for the PUBLIC OPTION, be it Medicaid and/or Medicare. (There may be other reforms I have not thought of.)
So to conclude, this idea really does what the original ORHC did - forces the Republicans, with their moved goalposts (i.e., originally it was HeritageCare to combat ClintonCare that was taken over and made into a coherent structure that would actually work) to accept that their ideas are carefully implemented, and not just a bunch of hot air. And I think that the ORHC has the wind at its back this time, and that considering the CruzCare (i.e., plank 3) plans as really THE last chance for the free-marketeers to be able to get something, so they should be motivated, and as well shut them up going forward since if their plans don't work out, we can say that we tried, and that Medicare-For-All is the only logical path left.
All that said, I do think that if properly done, these new plans can definitely help bend the cost-curve down, and any "lessons learned" there can certainly be adopted by the health-care industry in general.