National Review Online
Wednesday, April 05, 2017
We’ll admit that the progress House Republicans are
making on health care is well-disguised, but it is progress. The left-most
House Republicans have mostly been persuaded to support an important structural
reform of Medicaid. The right-most ones have mostly learned to live with tax
credits to allow people who don’t benefit from Medicare, Medicaid, or the tax
break for employer-provided health coverage to buy health insurance too. The
party leadership has slowed down its timetable for repeal and replacement of
Obamacare, even if that slowdown has come under duress and the pace is still
unrealistically fast.
House Republicans seem to be too divided still to pass a
bill, but the remaining distance ought to be bridgeable. What’s more, a number
of Republicans are talking up an idea that might accomplish that task.
The Republicans who dissented from the House leadership’s
bill from the right did so for two principal reasons: They did not think it
repealed and replaced enough of Obamacare, and as a result they did not think
it did enough to bring premiums down. The Republicans who dissented from the
left, meanwhile, did so mostly because they worried that the bill would leave
too few Americans with health insurance.
The idea that the House Republicans are now considering
would allow states to apply for waivers from Obamacare regulations, and direct
the secretary of Health and Human Services to grant the waivers if the states
show that their plans would have a positive effect on coverage. That ought to
be possible: Even the Congressional Budget Office, as biased as it is toward
government-centric solutions to health-care problems, has said that eliminating
Obamacare regulations would increase coverage by making it more affordable. The
waivers would be a way for House Republicans to address the concerns of the
party’s left and right simultaneously. As Yuval Levin explains today, the House
Freedom Caucus would get a bit of what it wants by demonstrating that the
moderates would get a bit of what they want.
As Levin also explains, whether this idea can be made to
work depends on the details. It is far from a perfect policy. States that used
the waivers would inevitably end up subsidizing states that didn’t: The waiver
states would have lower premiums and therefore less federal aid. (The same
dynamic already applies in the case of Medicaid: States that expanded it get
transfers from states that didn’t.)
But waivers would move us toward a health-insurance
system in which premiums were lower, private coverage was more widespread, and
the federal government played a smaller role. The chief obstacle to agreement
among House Republicans on this point, it seems to us, is that too many of them
are tired of negotiating with one another about health care. We have two pieces
of advice. First: Take a breather before resuming talks. Second: Pursue your
interests instead of your grievances.
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