It seems to me that the effort to repeal and then replace Obamacare was too big, too complicated, too hasty, and, ultimately, not ready for prime time.
The Freedom Caucus deservedly gets most of the blame for tanking Ryancare or Trumpcare or whatever the term of art for the AHCA is these days.
Their frontal assault on Obamacare was too politically risky, too partisan, and too easily turned away.
There is simply no way that Democrats would ever go for a plan that repealed President Obama’s number one legislative accomplishment.
Conservatives want to repeal the ACA because they and their constituents don’t like President Obama. That’s a crappy reason to make or repeal a law.
The GOP should think less about getting even with the former president and more about getting good policies into place.
I am tempted to say that Republicans should mend it, but not end it, but that is not exactly the right approach.
Instead, the smart policy and legislative strategists that are in the leadership should outline a four-year strategy to pass bite-sized, easily sellable fixes to Obamacare that make sense to the average voter.
First, they should pass tort reform to bring down the costs of defensive medicine.
Let the Democrats explain why they want to support trial lawyers over doctors.
Second, they should greatly expand Health Saving Accounts to give more power to consumers to control their own health care costs. They should give middle class voters – those making under 75,000 but over 30,000 a year – a refundable tax credit. Let the Democrats try to stop this health care break.
Third, they should try to take the burden off the middle class, who currently pay the bulk of the taxes to pay for Obamacare. More than 90% of the American people paid more taxes thanks to Obamacare. Only 7% of the American people got a net subsidy, thanks to the law. That is robbing a lot of Peters to pay only a few Pauls.
They should then do something about allowing insurance markets to sell across state lines. If you can get a better price in Maryland than in Virginia, why can’t a consumer shop there?
There are plenty of other bite-sized things that Republicans can do that will stabilize the exchanges by deploying free-market principles. There is no reason why Republicans should be forced to hastily pass a big omnibus package that is hard to explain and unifies the Democrats.
I was talking to a well-placed Senate staffer and he shared with me his strategy for dealing with Obamacare.
Here is how he put it:
- Define the problem by the big alternative (even if it fails to achieve a majority at the present); that’s the vision – lower costs, more choice, and fiscally sustainable, in GOP terms that are popular. This can’t be the tortured AHCA, which was designed to be jammed through and survive in reconciliation. It has to be the broader vision and not be the swiss cheese policy that reconciliation creates.
- Define the other side as resisting that favorable vision, i.e., make them defend the status quo.
- Chip away at the weak parts of the status quo (e.g., like D’s did with HIPAA, PBOR, Rx drugs, etc.) – insert GOP cut-and-bite reforms here, especially the ones that can ‘t go through reconciliation, if possible find Red State Democratic partners.
- Jujitsu the Senate Dem Leadership; they have the power to block these changes; the flip side is they own the warts of the ACA if they block cut-and-bite reforms.
- Voters need to be reminded of Democratic ownership of the ACA and enough repetition of step 4 will do so. Alternatively, maybe they agree to some of the reforms. In that case, good policy makes good politics.
This all makes sense to me. And he pointed out the track record of Ted Kennedy, who, in his time in the Senate, passed dozens of health care bills, many of which were enacted into law. He didn’t pass one big socialist bill that suddenly delivered a single payer plan. He passed a bunch of smaller bills that helped to get more people health care coverage, including HIPAA, the S-Chip program, the Medicare Modernization Act, and many more.
All of these bills lead to his bigger goal, which was expanded health care to more people paid for by more taxes.
A Republican vision would be to deliver more health care, at lower costs, using the power of the market and consumer choice.
Republicans have a president who will sign just about anything they want when it comes to health care. They have to be smart enough, though, to package it in smaller, bite-sized pieces in a way that will either garner Democratic support or put them on the defensive. And, of course, they have to get out of their own way.