Michael A. Needham is chief executive officer of Heritage Action for America.
President Trump’s young administration is not yet at a crossroads, but finger-pointing over the now-tabled Republican plan to replace the Affordable Care Act — also known as Obamacare — will only help the Democrats’ presidential nominee in 2020. Instead, conservatives should relish the opportunity to reset the debate.
Last week’s episode offers a few lessons for the Republican Party: Conservative commentator Reihan Salam suggested the “mad dash” to draft the GOP health-care bill wound up “alienating Freedom Caucus members who wanted to play an active role in shaping it.” And despite the bill’s multitude of problems — Trump said there were things he “didn’t particularly like” in the bill — conservative health-care expert Avik Roy noted that the “GOP’s right wing came to a surprisingly pragmatic realization” and “reoriented their efforts toward repealing most, if not all, of Obamacare’s insurance regulations.”
It was that pragmatic push that nearly resulted in a last-minute deal between congressional conservatives and the bill’s supporters. That the deal was so close suggests that House leaders could move quickly to bring the bill back to the floor with the inclusion of language that repeals more of Obamacare’s insurance regulations, such as federal mandates to cover comprehensive health benefits; actuarial values denoting different tiers of coverage; and community rating requirements preventing insurers from charging lower premiums for younger, healthier consumers.
Two questions loom large. First, why was repeal of Obamacare’s insurance industry mandates so controversial within the Republican Party? And second, why are congressional leaders and the president so eager to move on to tax reform?
Republican leaders insisted for weeks that the only roadblocks to deregulation were procedural, not political. But this claim came under scrutiny at the last minute, forcing Republicans to try to negotiate an overhaul of the essential benefits mandated under Obamacare. Moderates such as Rep. Charlie Dent (R-Pa.) in turn complained that party leaders had “pushed this bill too far to the right.”
Clearly, there is a policy divide that needs to be debated and negotiated. But there’s no reason to think Republicans wouldn’t be able to bridge that divide in the coming weeks — so long as they forgo their ultimatums for true deliberation.
We all want to ensure that citizens with preexisting conditions and other needs are cared for. That can be done far better, however, outside of Obamacare’s regulatory architecture. A deregulated insurance market would allow Americans to buy inexpensive insurance when they are young and carry it with them throughout their lives.
Indeed, “repeal and replace” became a rallying cry that transformed into electoral victory in November because 10 million Americans in the individual market who don’t get Obamacare subsidies will see their premiums skyrocket. The same is true for 15 million in the small-group market. In that light, deregulating insurance markets should not be viewed as a political minefield, but rather as an opportunity to provide citizens with coverage that makes far more sense for them than what government bureaucrats mandate.
The hard work of coalition-building, consensus-finding and implementing a legislative agenda to make America great again is exactly what our urgent times call for. It is also a far easier path to completing Trump’s ambitious legislative agenda than moving on to other priorities.
Some characterize an immediate pivot to tax reform as easy. But if party leaders move on before resolving the Obamacare dispute, they will find that there is a massive trust deficit on all sides that will make the path harrowing. And the policy itself will be less ambitious because the revenue baseline will remain roughly $1 trillion higher with Obamacare as the law of the land, giving Republicans less room to work with under congressional budgeting rules.
Already, concerns are emerging that unified Republican control of Washington will result in a permanent state of paralysis. That does not have to be the case, but progress requires a coherent governing vision that combines three elements: conservative principles, Trump’s brand of economic nationalism, and an understanding of the party’s significant and often intransigent moderate wing.
There is too much at stake to jettison that vision for the expediency of “moving on” to other governing priorities that seem less daunting. If Trump and congressional Republicans aspire to do more than recite campaign slogans, they should rally around policies that will actually drive down the cost of health insurance in America. That would be both great policy and good politics.
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