Instead of the long-awaited panacea promised during Obama’s presidency, Senate Republicans have, after years of impassioned rhetoric and legislative posturing, disconcertingly little to show for all their efforts. Presently, the only viable option is to reconsider Senate Majority Leader Mitch McConnell’s call for a repeal of the ACA, which would take effect in two year’s time and give Congress the opportunity to properly remedy the ACA’s ills. Repeal without simultaneous replacement doesn’t seem satisfying after years of waiting for sweeping reform. Yet, it’s sensible since a decent replacement bill is neither immediately possible nor desirable.
During the early days of Trump’s campaign, he gamely promised to “repeal and replace with something terrific.” As election season continued, the nature of this “terrific” healthcare plan remained nebulous and even when Republicans proposed well-defined plans, they were far from homogenous. Some, like Sen. Ted Cruz’s, involved thoroughly gutting the ACA with provisions allowing plans to be bought across state lines. Others, like House Speaker Paul Ryan’s, were less destructive and involved reformative changes to the individual market and Medicaid. Aside from projected increased costs for the elderly and lower costs for the young, Republican plans varied widely. This conspicuous absence of a unified vision is attributable to the Republican Party’s lack of a unified outlook.
But when Trump triumphed and gave the Republican Party possession of every branch of government, it couldn’t persist with hollow ACA repeal votes nor could Republican legislators continue to champion disparate visions for the ACA’s replacement. In order to fulfill the promise of “repeal and replace,” the widely loathed American Health Care Act of 2017 and its similar Senate companion bill were contrived. Both bills were intended to satisfy everyone’s discordant positions. Evidently, the GOP’s leadership are unfamiliar with Aesop’s fable of the miller who “in trying to please all…pleased none.” The planned legislation is problematic; even after initially praising it, the President reportedly termed it a “son of a bitch”—he wasn’t exaggerating.
The American Health Care Act and its Senate companion (the Better Care Reconciliation Act) would implement a variety of measures. Some are sensible, like reducing the income ceiling used for Medicaid eligibility, providing a tax credit for those below the poverty line, and eliminating employer and individual mandates and related penalties. Others are less sensible. For example, the bill would allow insurers—barring state legislation limiting the practice—to charge premiums up to five times higher to the elderly relative to the young, and it would repeal vital taxes on the rich and annual fees on health insurance providers. Additionally, according to the Congressional Budget Office, the bill would increase the number of expected uninsured in 2026 to roughly 22 million (relative to the ACA).
The outrage that followed the House bill’s unveiling was deafening. Not only did it earn the expected condemnation of Democrats and a welter of Republicans, but also in a comical instance of rare harmony, Heritage Action and the Center for American Progress both voiced their distaste for the bill. The Senate version of the bill, hastily written in secret and introduced last month, was found largely as unfavorable as its House companion. So far, it’s been brusquely rejected by Senators including Rand Paul, Cruz, Ron Johnson, and Mike Lee, while more continue to withhold support.
Bereft of the necessary consensus, late last Monday night, McConnell ditched the Republican healthcare plan and exhumed a bill previously passed by Senate Republicans and vetoed by President Obama, which would repeal the ACA with a two-year delay. If passed, the bill would allow Congress the time to devise an amenable replacement. Yet, despite the proposal’s sensibility, the President changed his tune on the replacement bill (for the third time) and at a lunch with senators last week, urged them to return their attentions to the bill he had so recently panned, saying, “I intend to keep my promise.”
Following the failure of Senate Republicans to pass the replacement bill on Tuesday, they likewise failed to resurrect McConnell’s full repeal bill on Wednesday and the defeat of the so-called “skinny” repeal early Friday, which would have at least removed penalties for those that neither obtain nor provide insurance and a medical device tax.
If anything at all is clear in the haze of the “repeal and replace” dialectic, it’s that there’s no easy way to replace the ACA, and that hurriedly-assembled replacement packages that try to incorporate everyone’s positions are sure to fail.
The problem with the Republican replacement bill is the same as the ACA’s: they’re legislative mélanges intended to address an ill-defined national demand for healthcare reform in one fell swoop. In other words, they’re inherently antithetical to the careful design of our republic’s legislative machinery. Two centuries ago, in A Disquisition on Government, Sen. John C. Calhoun wrote, “Nothing is more difficult than to equalize the action of the government in reference to the various and diversified interests of the community.” His observation remains astute; disparate interests are difficult to accommodate even with narrowly defined laws, and they become virtually impossible to accommodate when diverse legislative measures are amalgamated.
Instead of trying to conjure up a catholicon for healthcare, Republicans should have just passed a clean ACA repeal. If there is to be healthcare reform, it won’t emerge from one McConnell’s covert committees or a late night legislative blitz, but rather from a gradual aggregation of narrowly defined reforms—each arrived at after careful consideration and, when possible, successful functioning at the state-level. For example, instead of lobbying for its inclusion in a grandiose bill, Paul could introduce standalone legislation permitting association healthcare plans, and Cruz and Lee could introduce legislation akin to their recently proposed Consumer Freedom Amendment, which would allow ACA-compliant insurers to sell skimpier healthcare plans to younger customers.
A delayed repeal of the ACA is the only option that would allow for deliberative reform and is preferable to prolonging the GOP’s health care fiasco. Fortunately, our republic was not framed to swiftly produce and pass clustered legislation capable of shattering economic norms overnight, and the type of government that is, is precisely the type to which our nation was born in opposition.
Michael Shindler is an Advocate with Young Voices. Follow him on Twitter @MichaelShindler.