One of the great lessons in life is to "keep it simple." Yet, the most frequent violators are the people who should understand it best. I refer to the political class, specifically elected officials who (often unsuccessfully) engage needless complexities in lawmaking.
For example, there would be far more Democrats in Washington today if the drafting of Obamacare had not so violated the rule. Indeed, its primary author (Professor Jonathan Gruber) bragged that he made the language far more complex than needed -- the better to confuse the opposition and disguise the bill's heavy tax burden.
More recently, it has been Republicans' turn to cross a "simple" divide. As a result, much of the GOP base opposed an Obamacare repeal and replace bill that cut taxes, ended the individual mandate, defunded Planned Parenthood and block-granted Medicaid.
Talk about a lose-lose. A new GOP president was unable to bring his first major bill to the floor in a Congress controlled by his party, and many of the voters who put him there didn't know whether to be happy or angry (most were confused).
But that storyline is now so February. Speaker of the House Paul Ryan's leadership team used the previous bill as a predicate – then negotiated with enough "gettable" members to secure passage of a new bill, American Health Care Act, by four votes.
All in all, a positive result. Obamacare will not be allowed to simply wither on the vine. After all, the voters gave Republicans control in major part because Obamacare was dysfunctional. The GOP recipients of this political gift could ill afford to simply walk away as dire times approach. They were hired to fix it.
Going forward, the GOP must honor Rule One.
The AHCA must be artfully communicated. No Obama-like over-promising need occur. In the process, Americans should be reminded that the fracturing of Obamacare's provider networks and the inability of insurance carriers to make a profit are the real reasons the status quo cannot stand. Here, Trump must take the lead in communicating the ways in which his bill is preferable to its failed predecessor – how it will facilitate competition, lower premiums, and improve healthcare.
A few simple, easily understood planks for your consumption:
Obamacare's taxes are repealed.
The AHCA guts Obamacare's 21 new or increased taxes. Total tax relief is estimated to be $992 billion. (Spending is cut by $1.1 trillion.)
Consumer choice is restored.
The preservation of Obamacare's mandates within "Ryancare" required consumers to buy services they did not need at a cost they could not afford. But one-size-fits-all is expensive and hinders innovation. Potential purchasers were not impressed. Carriers suffered huge losses. Today, one-third of subdivisions are down to a single carrier on their Obamacare exchanges while two entire regions of the country have no carriers left. (Aetna and Humana have announced they will forego participation in all Obamacare exchanges in 2018.) Accordingly, the AHCA allows states to opt out of some mandates, thereby inviting more flexible, cheaper alternatives into the market.
Block-granting Medicaid is a big deal.
Everyone in Washington bemoans the bipartisan lack of interest in reforming entitlements. Recall that Trump promised "hands off" of entitlements on the campaign trail.
But the AHCA brings real change to a broken Medicaid program by providing states a fixed amount of money per beneficiary and flexibility on how to design their anti-poverty programs. (Such systemic change is already underway in a number of red and blue states operating under previously obtained waivers.) A historic redesign that allows states to move the program closer to its original purpose – subsidizing poor women with children and people with disabilities – is now doable, despite progressive cries of bloody murder regarding "lost" coverage.
Here, note that almost all of those who will see reduced or changed coverage under the AHCA are able-bodied, working-age adults.
Price must reflect risk.
Recall Obama's promise that Obamacare would lower premiums by $2,500 per family.
It failed to do so. Four election cycles later, the voters still have not forgotten.
How could they? New numbers from the Department of Health and Human Services reflect that average premiums in the individual market have increased 105 percent (over the past four years) within federally-run Obamacare exchanges.
Prohibitions on pre-existing condition disclaimers is the principal reason. No surprise here. It is difficult for underwriters to make a buck when the law stops them from…underwriting.
But a strong cultural value has emerged: people demand that older, sicker people not be priced out of the health insurance marketplace. Accordingly, the new bill subsidizes risk pools in order to cover more expensive patients in the individual market – a compromise that spreads the social cost of doing the right thing to all taxpayers.
Remaining consumers in that market will now be able to take advantage of more affordable policies as priced by more stable markets.
The initial attempt to repeal/replace gave all involved a black eye. The Democrats crowed. A new president fumed. The alphabet soup networks laughed out loud. GOP partisans wondered why seven years was not enough time for the Republican leadership to get its act together. But it was all first-quarter action. It is now the Senate's obligation to keep the offense rolling into the second half.
As a former member of Congress, I understand Ryan's original approach better than most. Senate Rules constitute a real obstacle to a comprehensive repeal and replace. And it's never easy to manage the conflicting demands of the moderates vis-à-vis the conservatives.
But the messaging failed. The GOP's talking points were ineffective.
Once the two chambers do their thing, a conference committee will be appointed. Whatever vehicle emerges will constitute a Republican legacy, up for a de facto referendum in November 2018.
Here's hoping that the GOP takes full advantage of this rare opportunity for a do-over. Only then will the messy memory of "Ryancare I" be put to rest.
Gov. Robert Ehrlich is a Washington Examiner columnist, partner at King & Spalding and author of three books, including the recently released Turning Point. He was governor of Maryland from 2003 - 2007.