Republicans Should Go Big On Obamcare ‘Fix’

Published February 13, 2015

Earlier this week I read an op-ed in the Wall Street Journal by Dr. Scott Gottlieb and Tevi Troy, two individuals I have a great deal of respect for. Titled “How Not to Bungle an ObamaCare Opening,” it argues Republicans in Congress need to be prepared to act swiftly in the event the Supreme Court rules in King v. Burwell that subsidies are only available through Obamacare exchanges established by states. This is something I’ve been saying for some time, so I certainly agreed with the basic premise. But I was disappointed when I read the actual op-ed, as it seemed to be to be far too timid in terms of what Republicans should seek given the opportunity.

I’d meant to write up my concerns, but didn’t get a chance to do so before Jeffrey Anderson of the 2017 Project wrote up his own objections:

But as Troy and Gottlieb demonstrate, Republicans are now flirting with negotiating bipartisan “fixes” that would make Obamacare about 80 percent as bad as it actually is — thereby effectively undoing Obama’s biggest political mistake.

Troy and Gottlieb write that, if the Supreme Court rules against the Obama administration in King, Republicans should “advance reforms that provide some immediate relief, start to turn ObamaCare in a market-based direction, and leave Mr. Obama in a political bind” by forcing him to sign these “market-based” reforms into law.  They add, “One of the most meaningful reforms would be to lift the heavy federal regulation of which insurance products can be sold in the exchanges,” thereby “reintroducing competition” to Obamacare…

But if Republicans really want to win a standoff with Obama in the wake of a favorable Court ruling, they need to go big and go bold.  They need to advance a circumscribed alternative that would effectively repeal Obamacare in the 36 states that would be affected by the Court’s ruling…

Exactly right. I tend to regard a lot of the discussion over whether to “fix” or “repeal” or “replace” or “reform” Obamacare to be a matter of semantics. That said, Republicans are likely to have more leverage than they’ve ever had if King v. Burwell is correctly decided, and they shouldn’t be looking for an opportunity to merely make Obamacare somewhat less damaging in exchange for preserving the general framework. They need to take a bill to Obama that is built from the ground-up on market principles, instead of trying to jam a few items into a “fix.”

Obvious things (to me, at least) to include in such a bill would be eliminating the essential health benefit mandates and the maximum out-of-pocket and deductible limits, implementing straightforward tax credits that can be used on or off the federal exchange, raising the contribuion limits on health savings accounts and allowing them to be opened and funded even without an insurance policy, repealing the individual and employer mandate. Block granting Medicaid should probably be in the mix too.

The opportunity to go to President Obama with a choice between signing legislation that preserves expanded access to health insurance based on market-oriented principles or vetoing it because it doesn’t conform to his ideological central-planning preferences, is only going to come around once. Republicans shouldn’t waste this opportunity by passing a timid bill that only sands off some of the rough edges of Obamacare, they need to go to him with something based on the principles they’ve espoused for years and dare him to veto it.