It’s a shame Senate Republicans are having such a difficult time getting their act together on healthcare. After all, “Obamacare: Reality Sucks” is playing all over the country right now, to dreadful reviews for familiar reasons.
Major carriers continue to flee Obamacare exchanges en masse, its co-ops continue to go belly-up (only four of the original 23 remain in business), and its networks continue to shrink. Without a massive influx of subsidies, the program’s demise is no longer “if,” but “when.” And our old friend, Professor Jonathan Gruber, is nowhere to be found.
Yet, despite all of this unraveling, recent polls reflect newfound support for the embattled program. The reform that contributed mightily to historic Democratic losses in the House and Senate is suddenly, if not popular, at least not so unpopular.
Alas, the public does not appreciate confusion when it comes to their healthcare. They understand Obamacare has fatal flaws, but what of the “replace” part of “repeal and replace?” Here, the GOP Senate’s bumbling and stumbling is embarrassing; its credibility diminishes by the second.
Meanwhile, Democrats have doubled down on defense of Obamacare. It seems that even four election cycles (and the loss of more than 1,000 seats in local, state, and federal legislatures) of voter retribution has failed to dampen progressive enthusiasm for President Barack Obama’s signature healthcare reform. This devotion to Obamacare is in one sense not surprising, since the law represents a tangible first step toward their ultimate goal: single-payer, government-sponsored healthcare.
At times, a sampling of Democrats will admit to Obamacare’s deficiencies, but usually in the context of condemning cold-blooded Republicans who turned the taxpayer faucet off just when Obamacare’s subsidies were most needed. (Note that this narrative ignores the ugly irony that the intended beneficiaries of additional taxpayer largesse are the big, bad insurance carriers who require subsidies in order to keep offering plans that are otherwise unprofitable.)
It is now eight years later, and decision time draws near. A “replace” bill will have profound consequences for our healthcare delivery system. Accordingly, this is the time and place when real political leaders earn their money – and their legacies.
The Left smell a paper tiger. They know many Republicans like to talk the talk at Lincoln Day Dinners; that throwing spitballs from the bleachers is the easiest thing to do in politics.
But it’s a different ballgame when real votes bring real consequences to real people. Suddenly, your “safe seat” is competitive because the Democrats have run a million dollars of “mediscare” commercials against you.
The bottom line: Democrats do not believe enough Republicans have the chutzpah to make tough votes, that the GOP lacks the courage to eliminate goodies previously awarded to the voters — especially when a government entitlement program is at issue.
Something close to the Senate healthcare draft can counter this narrative, especially one that includes the modernization that transitions Medicaid to per capita block grants and returns all enrollees to the traditional (approximately) 50/50 federal/state match rate that existed prior to Obamacare. Recall many governors of both parties bought into Obamacare in order to access Washington’s “free money” for new able-bodied enrollees, a win-win for fans of the welfare state, and a “success” that has resulted in one in four Americans now covered by the program.
But their “victory” has helped further expose Medicaid’s subpar service regime. The number of participating physicians has dropped as reimbursements are cut, while Medicaid spending continues to exert immense pressure on federal and state budget deficits. Indeed, Medicaid spending now represents 10 percent of the entire federal budget.
The Senate draft is therefore a rare opportunity to control what amounts to an open-ended federal entitlement. This is a big deal.
A decent compromise on Obamacare’s community rating mandate is another step in the right direction. As discussed in previous columns, expanded pricing options as a function of age more accurately reflect market costs even with the inclusion of pre-existing disclaimers.
A potentially winning Republican narrative emerges: Able-bodied, non-poor men are given the opportunity and (responsibility) to purchase an insurance policy that best suits their circumstances. The vast majority of this healthy subgroup will be covered by inexpensive, high-deductible catastrophic policies while people who have experienced more problematic health histories (those with pre-existing conditions) will continue to have access to affordable health coverage.
Note the Senate draft does not contain the House repeal of Obamacare’s taxes – presumably to mute the Democrats’ mantra of “tax cuts for the rich and service cuts to the poor.” This will of course not diminish Democratic fondness for class warfare rhetoric, but it does free up dollars to meet GOP moderates’ demands for additional spending on out-of-pocket costs and the opioid epidemic (albeit not enough to date).
The end game is fully in the GOP’s court. Few of its supporters will be satisfied with a failed attempt at “repeal and wait for two years.” Rather, the choice is clear: Either lead or be exposed, either wilt or show the voters that a federal entitlement can be reformed, either pass a bill that lowers premiums or expect a “what for?” from voters come November 2018.
How wonderful it would be if the GOP chose to compete — pass a bill, celebrate healthcare choice — and then went out and won the 2018 mid-terms on a “can do” platform.
One can dream, right?
Author’s note: Even as he battles brain cancer, Sen. John McCain has a message for those who plan to stand in the way of true progress: “I greatly appreciate the outpouring of support – unfortunately for my sparring partners in Congress, I’ll be back soon, so stand-by!” I wish my friend Godspeed.
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.
