Conservative policy experts and strategists continue to quietly meet and craft a legislative replacement for Obamacare, and with good reason.
People are hurting under the current broken system that denies individuals control over their own health decisions while hugely driving up their costs. Premiums have been rising by ungodly amounts (an average of 37 percent in 2018), while nearly one-third of all counties feature just a single insurer offering coverage in an Obamacare exchange.
The conservative strategists see a moral imperative to fix these problems. They also see the healthcare reform effort as a political necessity – and they’re right on both counts.
On the politics, the polls already look horrendous for Republicans anyway, and the Left will be energized in this fall’s elections no matter what. The only way to counter their energy is by exciting right-leaning Americans to turn out as well. If Obamacare remains in place, though, the Republican base will be thoroughly demoralized and stay home from the polls.
“[Repealing Obamacare] was the number one priority that caused us to win three of the last four election cycles,” former Sen. Rick Santorum, R-Penn., told me on Wednesday. “To give up now would be political malpractice.”
Moreover, 2018 might be the only chance to get the job done. Republicans could easily lose a House majority in this year’s elections – and if they do, Obamacare replacement is not just dead, but unresurrectable.
Despite this wisdom, Senate Majority Leader Mitch McConnell is reportedly considering bypassing entirely the annual budget resolution that, with proper “reconciliation” instructions attached, would be necessary to repeal Obamacare this year. He seems to think that failure in 2017 ensures failure forever.
McConnell is wrong. The conservative strategists are busy building a plan better both substantively and politically than the ones that failed last year. Free-market elements of it are likely to appeal to formerly recalcitrant Republican senators such as McConnell’s Kentucky colleague, Rand Paul, and premium-mitigation incentives might attract moderate Republican doubters such as Maine’s Susan Collins. A real chance exists that a new plan can secure the votes needed for passage.
Multiple sources have said, and Santorum confirmed, that current discussions envision using the nearly-successful Graham-Cassidy legislation from last year as a template, but with at least four ideas on the table (details to be worked out) for important modifications.
Graham-Cassidy effectively would have turned federal healthcare policy into a system of block grants to the states to design their own health coverage systems. Four of the main ideas (among others) for tweaking it include: 1) a requirement that part of the block grants be used in support of private marketplace options; 2) some provision of risk mitigation to keep premiums lower; 3) a choice even for individuals served by state-government-run plans to opt out and use the money in the private market; and 4) a considerable expansion of Health Savings Accounts and/or Flexible Spending Arrangements.
In all these and other modifications to the original Graham-Cassidy bill, the emphasis will be on expanding the choices and control of individual patients. State systemic designs would replace federal government mandates, and individual control would replace bureaucratic straitjackets.
And, with market forces more in play, the costs to both patients and taxpayers should be held in check.
“Substantively, it would be unconscionable to leave 30-40 million people, in the individual- and small-group-markets, stuck in today’s failed system of higher costs, lesser access to care, oftentimes worse care, and fewer choices,” Santorum said. “Choice; control; security: Those should be our watchwords.”
Congress absolutely ought to pass a budget resolution, to give the improved Graham-Cassidy framework one more chance of passage. Meanwhile, Republican message crafters should make a concerted effort to explain the new proposal to the public – to show, indeed, that it would provide lower costs, more individual control, and better healthcare security.
Republicans still have majorities in both the House and Senate. There’s no excuse for failing even to try to use them for the biggest domestic policy imperative of the decade. To refuse the attempt would be sheer political cowardice.
To try, and to succeed, will show that representative government, despite diagnoses to the contrary, remains in good health.
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, and is the author of Mad Jones, Heretic, a satirical literary novel published in the fall of 2017.
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