It’s a foregone conclusion the new Republican-controlled U.S. Senate will join the House in voting to repeal the Affordable Care Act (ACA), or Obamacare as it’s more unpopularly known. It’s also a foregone conclusion the effort will fail.
The repeal bill may be filibustered by Democrats, or it might manage to sneak through the reconciliation process and actually wind up on the president’s desk, where he will promptly veto it.
That is likely to be just the start of Republican efforts to undo Obamacare. Full repeal won’t make it through, but Congress may pass a ‘defund Obamacare’ bill that leaves the law in place while eliminating funding for tax credits or the Medicaid expansion. That will provide more fodder for the president’s veto pen.
Even though failure is certain, Republicans shouldn’t shy away from these votes. Repeal votes are important not just to satisfy the political base but also to continue to remind the public of the failings of Obamacare, such as cancelled plans, higher premiums, only modest reductions in the number of uninsured, and a budget-busting expansion of a failing Medicaid program.
Just as important will be bills on smaller but still important issues, some of which may even get Democratic support, including the president’s signature. Republican leaders have already signaled they will vote on items such as repeal of the individual and employer mandates, eliminating the medical device tax, setting the definition of full-time work at 40 hours, and ending handouts to health insurance companies that lose money on the exchanges.
But then what? Republicans could spend the next two years passing small pieces of legislation that scale back a few of the more unpopular or damaging parts of Obamacare and hope for a Republican president in 2017 to sign a full repeal. The danger, of course, is there may not be a Republican president in 2017, or even a Republican Senate.
Given this possibility, Republicans should try to make some serious, lasting reforms now that can move health care toward a more market-oriented system and can’t easily be undone by a future Democratic Congress and president.
Such reform would have to attract enough Democratic votes to avoid a filibuster and also appeal to the president. That may seem impossible, but it really isn’t. To get Democrats’ support, Republicans will just have to give them something they really, really want.
I suggest we give them single payer, which Democrats and the left have salivated over for decades.
Not as a mandate, of course. Instead, Republicans should pass legislation allowing individual states to use funds from Obamacare’s tax credits and Medicaid to pay for a single-payer system, along with other policy changes such as allowing states to ban employer-provided insurance.
Why would advocates for free-market health care give Democrats the power to impose single-payer health care in the states? Because the legislation allowing a state to adopt single-payer would also permit other states to chart a different path, including a free-market system in which insurance and health care are largely deregulated, the poor are given vouchers or tax credits allowing them access to the same health care system as everyone else, and a real market with real prices is allowed to flourish.
Vermont is currently trying to figure out how to enact single-payer, and it is struggling in large part because of policies dictated by Washington, DC. Several Republican governors, on the other hand, support free markets and would certainly like to free themselves from federal constraints in order to enact serious health care reform.
Legislation allowing each state to chart its own path on health care would allow states to develop free-market health care systems if they like or single-payer if they prefer. Ultimately, that sort of freedom to innovate would be good for all, as states learn from each other’s successes and failures and compete to provide the best health care system at the lowest cost.
The Republican congressional majorities should aim for bold, sustainable reform while they have the chance, and they need to be smart and innovative in order to achieve it. Giving states the power to succeed or fail with single-payer or free markets is the best way to do that.