Early troubles facing the rollout of President Obama's health care law have renewed the debate among Republicans over what type of policy alternatives to offer.
Republicans agree with the basic idea of reforming the system to give Americans more control over their health care dollars, thus driving down costs, increasing access and improving quality as markets react to consumer choices. And several GOP lawmakers have offered their own proposals to move in that direction, which tend to involve ending the bias in the tax code in favor of employer-based insurance and replacing it with tax credits or deductions to individuals.
To be sure, a lot of this has to do with GOP's long-standing aversion to health care policy. During the period after the failure of President Clinton's health care push in 1994 and before Obamacare passed in 2010, Republicans did very little to put a conservative stamp on health care policy, besides injecting a few market reforms into an otherwise massive expansion of government in the form of the Medicare prescription drug program.
But between 2010 through the end of 2012, as long as repealing Obamacare or overturning it in the courts remained a possibility, Republicans didn’t see much of a reason to introduce major health care legislation.
In 2013, much of the news was dominated by the Republican effort to defund Obamacare as well as the botched implementation of the program.
The difficulty for Republicans seeking to craft a health care policy at the moment is that it’s very difficult to predict what the health care landscape will look like a few months from now, let alone several years from now when a potential Republican president would have a chance to make changes.
Without knowing how much of Obamacare could be in play, it’s hard to settle on a policy. On the one hand, basing policy on the assumption that Obamacare can be entirely repealed is likely unrealistic, while on the other hand, treating Obamacare as mostly untouchable could cause Republicans to preemptively concede too much policy ground. Mounting failures of Obamacare could put more of the law in play than seemed possible just a few months ago.
Most likely, the future of Republican health care policy will be sorted out as its presidential candidates begin to lay out their plans during the 2015 primaries. But those candidates will have to adopt policies in an environment that’s largely a product of what happens in 2014.
Though a lot of uncertainty surrounds the health care world in 2014, there are three basic scenarios.
Under one scenario, Obamacare overcomes its early troubles and turns into a smashing success, extending insurance to millions of Americans while causing little or no disruption to the vast majority of citizens. In this unlikely set of circumstances, the Republican policy response to Obamacare is likely to be quite modest.
Under a second scenario, Obamacare would end up ironing out some of its early wrinkles, but would still leave a lot of people complaining about poor access to doctors and hospitals, rising costs and too few choices. This could cause some Republicans to concede to keeping the law’s exchanges, but deregulating them to make it easier for individuals to purchase less comprehensive health insurance that’s cheaper or covers a wider network of providers. Or to propose alternatives to covering individuals with pre-existing conditions as well as scrapping the individual mandate.
Under a third scenario, individual insurance markets would collapse due to a failure to attract a critical mass of young and healthy consumers and Americans would be rebelling against reduced access as insurers pare provider networks. In such a case, Republicans are unlikely to abandon their efforts to repeal the law.
By this time next year, we will know which scenario played out.