National Review Online
Tuesday, July 18, 2017
Moderate Republicans campaigned for years on repealing
and replacing Obamacare, but a few of them balked at the first opportunity to
do it. A few conservative Republicans refused to go along with health
legislation that fell short of repeal, even if it reduced Obamacare’s spending,
taxes, and regulation. So now Senate Republicans are short of a majority for
their health bill, and wondering what to do next.
We think both camps of no votes have erred, although the
conservatives have done so more defensibly. They wanted to keep their party to
its promise, and rightly observe that a more deregulatory bill would do more to
reduce premiums. We also think that the process by which the bill was advanced
— with no actual sponsors making the case for it and defending it from
misrepresentation, and with a palpable desire to get it done quickly — has made
it harder to pass. That said, it’s hard to defend the objecting Republicans’
failure even to allow a bill that most of their colleagues in the party
supported to get a debate on the floor.
The question now is what to do next. Senate majority
leader Mitch McConnell says that Republicans will now consider the bill they
sent President Obama in 2015. It would repeal Obamacare’s taxes and spending,
effective a few years from now. They say that would give Republicans time to
come up with a viable bill.
It is a terrible strategy. It would require moderates to
vote for a bill that involved a greater reduction in the insurance rolls than
the one they just rejected. It would require conservatives to vote for a bill
that did less to relax Obamacare’s regulations — more precisely, that did
nothing — than the one they just killed. And it would be premised on the
prospect of a Republican agreement on replacement that they would have just
quit trying to reach.
There is an alternative, if not a very satisfying one.
Republicans seem to be able to achieve near-unity on ending the individual
mandate, allowing insurers to offer discounts for younger people, protecting
taxpayers from having to subsidize abortion coverage, and giving states some
freedom to relax regulations. They should work for legislation that achieves
these goals and includes as much Medicaid reform as 50 senators are prepared to
tolerate.
Republicans should not claim that such legislation would
repeal and replace Obamacare, since it would not, and should make it clear that
additional legislation will be needed in the future. The conservative holdouts
should be prepared to judge this limited legislation based on whether it gives
people more freedom to choose the health insurance they want, not on whether it
does everything for which Republicans have been campaigning over the last seven
years.
Whether more taxpayer money should be given to insurance
companies to stabilize Obamacare’s markets, as Democrats will surely demand,
should be left to another piece of legislation. Republicans should be open to
passing it, given the continuation of Obamacare, but only in return for more
reforms.
It has become painfully clear that Republicans do not
have sufficient consensus to move us definitively away from the Obamacare model
of health policy. That frustrating fact should not be an excuse for
accomplishing nothing.
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