The Republican House leadership’s Obamacare replacement bill may be deeply flawed, but some of the complaints from its most conservative critics amount either to hypocrisy or to sheer ignorance combined with camera-seeking demagoguery.
Many of the bill’s flaws are sins of omission – of failure to repeal Obamacare regulations due to exaggerated or mistaken fears that those regulatory changes would not pass procedural hurdles in the Senate. Criticism on those fronts is justified.
What carries the stench of hypocrisy, though, is the hard-liners’ complaint that the bill’s “refundable tax credits” are a deal killer because they amount to a supposedly unwise government “subsidy” for healthcare. The hypocrisy lies in the fact that so many of the critics actually signed onto prior bills whose central component was a refundable tax credit – and, indeed, for years the most prominent conservative Obamacare-replacement bills have featured those credits.
The leading double-talker is Rep. Mark Meadows of North Carolina, chair of the House Freedom Caucus – a group even more hard-line than the longstanding conservative caucus called the Republican Study Committee. In multiple interviews, Meadows has repeatedly blasted the refundable credits for somehow amounting to “a new entitlement program.”
This is the same Meadows who just two years ago signed on as a co-sponsor of the Empowering Patients First Act of 2015, authored by then-Rep. Tom Price, who now is secretary of health and human services. The official summary for that bill starts with one sentence saying it would replace Obamacare; then the very next sentence – the first sentence explaining the actual substance of the act – reads as follows (my emphasis added): “The bill provides for refundable tax credits for health insurance coverage and health savings account (HSA) contributions.”
Was Meadows so careless two years ago that he was utterly ignorant of the main feature of the bill he co-sponsored? Or has he had some sort of intellectual revelation that completely changed his mind but that he didn’t bother to explain? Or is he just a showboat looking to capitalize on a general conservative tendency to trash every proposal as not good enough and not pure enough? Does he even care that he is completely contradicting himself?
If the tax credits are such an obvious betrayal, why have solid conservatives supported them for so long? The House Freedom Caucus has yelled loudly against the leadership’s replacement bill, but among the other caucus members who signed onto Price’s tax credit bill two years ago were Reps. Jeff Duncan, Scott Perry, Trent Franks, Scott DesJarlais, Steve Pearce, Ted Yoho, Randy Weber, and Mark Amodei – along with noted budget hawk Mick Mulvaney, who now heads the new administration’s Office of Management and Budget.
Outside conservative groups are clamoring against the refundable credit as well. One of the most vociferous has been Heritage Action, the political arm of the Heritage Foundation think tank. This seems like the far right hand not knowing what the right hand has been doing. For years, Heritage scholars such as Bob Moffitt have praised plans that, like Price’s bill of two years ago, included such credits.
For example, conservatives almost universally praised what was known as the Coburn-Burr-Hatch healthcare plan when it was unveiled in 2014. The key feature of C-B-H was, you guessed it, refundable tax credits.
The critics ignore the political reality that Americans have certain expectations about healthcare, and that they rely on certain systems (such as Medicaid for the poor and disabled), that just aren’t going away. Conservatives rightly decry the quality and cost of Medicaid, and say it would be better to give low-income Americans free-market choices while keeping prices down by fostering competition by providers. All conservative plans therefore put an eventual “cap” on further expansion of Medicaid.
But the biggest political and moral risk of reform is the problem of leaving low-income people without access to insurance or care. If Republicans cap Medicaid without offering refundable credits, they almost certainly would be guilty of exactly the heartlessness for which liberals accuse them.
Refundable tax credits may not be the best solution. But they aren’t an abomination, are not a new entitlement – and they are, quite clearly, well within the acceptable conservative policy basket.
If you don’t think so, just ask the 2015 version of Meadows – before he put his finger in the current starboard winds.
Quin Hillyer (@QuinHillyer) is a contributor to the Washington Examiner’s Beltway Confidential blog. He is a former associate editorial page editor of the Examiner.
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