National Review Online
Friday, July 14, 2017
Congressional Republicans should stop calling their
health-care bills a repeal of Obamacare. The House bill is not one — it keeps
Obamacare’s regulatory heart — and the Senate bill is even less of one now that
it has been amended to keep some of Obamacare’s most economically destructive
tax increases. And because the bill is not a real repeal, people will face some
combination of higher premiums, co-payments, and deductibles than they
otherwise would. Moderate Republicans, who said for years that they wanted to
repeal Obamacare but apparently never thought through what repeal would entail,
are mostly to blame for these disappointing facts. Republicans have failed to
make good on their promises.
But there are two further questions that conservatives
should ask about the legislation. The first is whether the bill, disappointing
as it is, represents a substantial improvement over the status quo. The second
is whether modifying the bill in a House–Senate conference would be likely to
yield better results than letting it die. In both cases, we think the answer is
yes.
The bill cuts taxes, restrains spending, and — courtesy
of the tireless efforts of Senators Ted Cruz and Mike Lee — modestly
deregulates. It ends Obamacare’s obnoxious fines on people who go without
health insurance. It would be likely to yield lower premiums than keeping
Obamacare as it is — although supporters of the bill should be careful not to
promise too much on this front. Its Medicaid reforms would control the growth
of that program, give states a stronger incentive to police fraud and seek
efficiency, equalize funding between Medicaid’s new beneficiaries and its
poorer traditional ones, and provide some help for people who wish to move from
Medicaid to private insurance. It could produce a larger individual insurance
market by attracting a greater number of young, healthy people who voluntarily
choose to enter it. The bill blocks federal funding for Planned Parenthood, the
nation’s largest abortionist, and includes a provision to prevent taxpayer
subsidies for abortion coverage.
The current draft of the Senate bill should not be the
last word. Republicans should restore as many of the tax cuts to the bill as
possible. The bill should be more aggressive in helping those who wish to leave
Medicaid. Pre-funded health savings accounts would allow them to pay the
deductibles for catastrophic policies while also retaining incentives to
control costs.
We would, however, recommend that conservative senators
vote for the bill — and that all Republicans do a better job of defending it
from the Left’s hysterical attacks. The bill would not “throw 22 million people
off insurance,” the Congressional Budget Office has not said so, and Democrats
and reporters who claim otherwise are telling untruths. The bulk of the CBO’s
22 million would voluntarily drop insurance if not threatened with fines.
Obamacare hasn’t been shown to have saved any lives (mortality trends since its
implementation are not especially encouraging), and there is little reason to
expect a partial repeal of it to endanger any. Nothing in the bill requires any
state to roll back eligibility for Medicaid. And so on.
Voting for a bill that has been so demonized and
distorted would pose a political risk for senators — especially since so few
conservatives are truly enthusiastic about the bill and since Republicans would
become part-owners of a frequently maddening health-care status quo. But the
alternatives look worse. Republicans would probably have to pass an
insurance-company bailout to keep Obamacare’s exchanges going if they fail to
pass this bill; and some measure of political responsibility for the
health-care system is inevitable given Republicans’ control of Congress and the
White House.
They could be using all that power more effectively to
foster a functional health-insurance market with a more appropriately modest
role for the federal government. But they are taking significant steps to
advance that goal, and conservatives should accordingly support them.
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