U.S. House factions trying to revive legislation reforming health-care policy should consider not just changes in bill language but several changes in outlook as well.
First, they should stop thinking of this effort as "the" sole bill to "repeal and replace" Obamacare. Second, they should measure the bill not against all future policy hopes, but against existing law. Third, everybody involved – especially President Trump and House Speaker Paul Ryan – ought to trumpet and explain in easily understandable terms, a major new concession they would make to build political support for the bill.
And (fourth), speaking of political support, the White House, in particular, must do far more to make a public case for the benefits of the entire enterprise.
With regard to the first two points above, the simple fact is that if the last public version of the American Health Care Act had been considered not as Obamacare repeal but merely as an effort to improve upon existing law, most of the same conservatives who trashed it would instead have been celebrating it as a terrific move forward – on multiple fronts.
Indeed, several conservative opponents of the bill have told me as much.
The reality is that few congressmen promised to "repeal Obamacare in one vote," but merely to "repeal Obamacare." Why should it matter to them if it takes several steps? Why should the failure to immediately and fully "repeal" Obamacare keep them from making major improvements in the meantime?
Just call it something modest like the "Health Policy Improvement Act" and start bragging about its achievements.
Even the flawed AHCA bill pulled from consideration last month included provisions that would amount to immense victories for conservative policy aims. For well over 20 years, conservatives have wanted to "block grant" Medicaid to the states. The AHCA would have gone a long way in that direction. For almost those same two decades, conservatives have wanted "work requirements" for able-bodied Medicaid recipients. This bill would have started that process in exactly the same way that successful welfare reform was begun: by encouraging states to experiment with such policies for several years before full national reform was accomplished in 1996. It also would stop funding any further state expansions of Medicaid.
AHCA proposed to cut nearly a trillion dollars in taxes over the course of a decade. This is conservative nirvana. Among the taxes eliminated would have been the medical-device tax that has kept life-saving help from patients while destroying many thousands of jobs.
Even taking tax cuts into account, the AHCA would have achieved net ten-year federal savings of well over $100 billion, helping reverse the horrendous pace of growth in federal debt. Fiscal conservatives should have rejoiced.
The AHCA would have killed Obamacare's "individual mandate" and "employer mandate," expanded patient choice, moved health policy back in a free-market direction, defunded Planned Parenthood's abortion mills (thank God!), vastly expanded Health Savings Accounts, and encouraged states to create high-risk pools. Every one of these policy changes are ones conservatives have sought for years.
It would be foolish not to make these reforms, bank them, and then go back later for more.
Still, conservatives from the House Freedom Caucus and moderates from the Tuesday Group both probably need something they can tout as a "new" concession from House leadership – a new policy achievement of benefit to patients – that they can use to explain why they moved in just two weeks from "no" to "yes."
One such change would be to eliminate Obamacare's Independent Payment Advisory Board (IPAB) – a hideous feature intended for Medicare cost control but expected, when fully operational, to lead to heartless and arbitrary rationing of care for the elderly. To moderates, this could be sold as a way to maintain support from the senior citizens who tend to vote more Republican than young voters do. It also would bolster their support from "establishment" groups like the American Medical Association and its subsidiaries, which have agitated for repeal of IPAB for years.
For conservatives, this is a chance to kill the remaining provision of the infamous "death panels" blasted by Sarah Palin back when Obamacare was created. At different times, there actually were two provisions identified as "death panels" – one a payment for end-of-life counseling, the other one the mandatory cost controls IPAB is empowered to implement. It certainly would be politically useful for Freedom Caucus members to return home saying they refused to support the AHCA until the death panel was eliminated.
Granted, some of this is "merely" public relations. But when it comes to good policy, public relations should not be "merely" a consideration but an essential one. So far, the administration has done next to nothing to sell its healthcare bill to the public. No major rallies. No big press conference. No Oval Office address.
If the administration won't explain its legislation, how can the public be expected to understand it – much less approve it?
The best way to get House members to "yes" is to convince their constituents to tell them "yes" is the right answer.
The AHCA effort ought to be salvaged. With some changes in attitudes, it can be.
Quin Hillyer (@QuinHillyer) is a contributor to the Washington Examiner's Beltway Confidential blog. He is a former associate editorial page editor for the Washington Examiner.
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