Despite assertions to the contrary from the media and the left, Republicans do have a plan for health reform—but it will not be another 2,000-page behemoth attempting to re-engineer our health sector from the top down, with a conservative twist.
Conservatives have seen from the failed experiment with Obamacare the hubris of believing politicians can write enough laws and regulations to control one-sixth of the American economy. It does not work, and they do not plan to repeat the liberals’ blunder.
Instead, they will replace this failed health law through a step-by-step enactment of a market-friendly reform that provides a safety net for those currently on the program, gives states more authority to oversee their health-insurance markets, and provides states with revenues to help those who have difficulty purchasing or affording health insurance. They also will begin the desperately needed process of modernizing the Medicaid program to provide access to care instead of an often-useless insurance card.
Congress is working to create a lifeboat and a bridge with its repeal-and-replace agenda. The replacement measures will protect the people who are on Obamacare now so they don’t lose their coverage again, and they will build a bridge to new coverage that will protect others from the damage that the law has done to their pocketbooks and the quality of their medical coverage.
“We want to do this at the same time, and in some cases in the same bill,” House Speaker Paul Ryan said during a town hall this month sponsored by CNN. “So we want to advance repealing this law with its replacement at the same time.”
But they must begin with repeal. Consumer-friendly reform policies cannot be built on top of the Obamacare wreckage.
After Republicans took control of the Senate in the 2014 elections, they wanted to fulfill their campaign promise to repeal Obamacare but lacked the 60 votes needed to block a filibuster. So they followed the labyrinth of the budget-policy “reconciliation” process to pass House-initiated legislation with a simple majority vote in the Senate. They sent a repeal bill to the president a year ago, and to no one’s surprise, President Obama vetoed it.
So why didn’t Congress pass its own replacement legislation after that? Because the Republicans still lacked the necessary 60 votes in the Senate and would not expect any Democrats to vote to replace the law they were defending on the campaign trail. Republicans have only 52 seats in the Senate this year and must either coax some Democrats to join them on the replacement bill (or bills) or try, once again, to pass it through reconciliation.
Still, far too many people who should know better are saying the reason they haven’t passed a bill is that Republicans don’t have a plan. But there is a long list of members of Congress and outside organizations that have developed consumer-friendly health-reform plans, including Dr. Tom Price, the representative from Georgia who is Mr. Trump’s nominee to head the Department of Health and Human Services.
Any one of these plans could have been introduced as a platform for developing replacement legislation. But the media then would have mocked Congress for going through such a stupidly futile exercise. A replacement bill would have been a huge waste of time because it would have faced the same veto pen.
Instead, Speaker Ryan ordered the House to spend the first half of last year coming up with a plan. All four key committee chairman of jurisdiction were heavily involved in the process and engaged members of their committees and the rest of the Republican caucus in conversations over how to shape it. House staffers met over the year with countless outside groups to get input.
The process resulted in the “Better Way” plan that the speaker released in June. It is a detailed and comprehensive plan that answers the key challenges of reform—how to cover millions of uninsured, make coverage more affordable, protect those with preexisting conditions, and give people more choices of plans. It was part of a broader agenda to show the policies Congress would pass on tax reform, regulatory rollback, defense policy, and a number of other crucial issues—if they had a president who would sign the legislation.
Why don’t you know about this? Because the media preferred to ignore it, adopting instead the mantra that, well, we might as well keep Obamacare because Republicans don’t have any ideas.
Republican policies will be much more flexible and consumer-friendly than the one-size-fits-all policies that Obamacare mandates. That can come about only by devolving power to the states to oversee their health-insurance markets and encouraging carriers to offer an array of policies so people can purchase the one that best meets their needs. Those at the lower end of the income spectrum will receive financial help. States will be provided with additional revenues so they can provide added financial assistance to those who need it.
People will be encouraged to buy and keep coverage because it will be harder to get a policy if they wait until they are sick to buy it. One of the reasons Obamacare is collapsing is that those purchasing policies are increasingly older and sicker—and more expensive to cover. Younger, healthier people are dropping out, with 7 million of them opting to pay the penalty tax for not complying with the individual mandate. Making coverage more attractive and affordable will bring them back into the market so it can begin to stabilize.
Republicans’ repeal legislation would allow those on Obamacare now to keep their coverage for at least two years while the new policies take root. The Congressional Budget Office ignored the replacement provisions in its narrow analysis of the expected consequences of the repeal effort.
While their rhetoric is different, there really isn’t a lot of daylight between the position on the uninsured taken by Speaker Ryan and President-elect Trump: both envision a system that allows anyone access to health insurance. President-elect Trump told the Washington Post in an interview he would seek to provide “insurance for everybody.” Paul Ryan agrees that legislation should protect “people with pre-existing conditions, no matter how much money they make.”
Ryan also said everyone should have access to insurance that gives people choice and gives markets a chance to provide products they want to buy. A guarantee that everyone must be covered, by contrast, involves a slew of mandates—on individuals, employers, and insurers—with tens of thousands of regulations à la Obamacare, a battle-worn approach that has been rejected by the American people.
President Obama came to Capitol Hill earlier this month to plead with Democrats to preserve his legacy and stop Republicans from repealing the law. They might be reminded that he made a similar visit in 2010 to plead with them to vote for the health law, promising them they would be congratulated and rewarded for their votes. Sixty-three of them lost their seats that year. Members of the 115th Congress might want to heed that lesson.
Grace-Marie Turner is president of the Galen Institute, a nonprofit research organization focusing on patient-centered health reform.