There are a lot of squishy, pro-big government talking points circulating in defense of House leadership’s American Health Care Act – the ostensible Obamacare “replacement.” It has split the Republican Party in twain, because it doesn’t actually repeal OR replace the onerous 2009 law.
In the immediate aftermath of the bill’s introduction, the wagons have begun to circle, conservatives have already introduced a competing alternative, and Republican leadership and its acolytes have already begun an entrenched defense of the secretly negotiated legislation.
Here are some of the arguments you’ll likely hear in defense of the bill, complete with responses.
1) “It repeals Obamacare”
It really doesn’t. Ask yourself, “What is Obamacare? What parts of the law are creating the worst problems in health insurance markets?” Obamacare is a regulatory structure of mandated insurance benefits, artificial marketplaces known as “exchanges,” and subsidies.
The GOP plan gets rid of some taxes, but – as Daniel Horowitz explained at length Tuesday – it retains the worst parts of the ACA while only removing the less egregious portions piecemeal.
The mandated essential benefits were not repealed. The exchanges remain in place. And while some subsidies are cut, most are not repealed until 2020 … when they are replaced with a new entitlement program.
This is a Repeal in Name Only, by Republicans in Name Only.
2) “It will lower costs”
The chief factor driving costs up under Obamacare are the insurance regulations, the worst of which are retained in this bill.
Among the chief complaints against Obamacare for years now has been the rising health insurance premiums that millions of Americans cannot afford. The American Health Care Act cuts subsidies and taxes, but the things that make it more expensive for insurers to operate and difficult for market disrupters to compete are the “thou shalt” insurance mandates.
These rules, which compel insurers to cover certain medical procedures – like pap smears for men – keep the market cost of insurance artificially inflated and limit the consumer’s choices. Because the GOP plan does not address these cost-increasing mandates, insurance premiums will continue to rise and the Republican Party will get stuck with the blame at the ballot box.
3) “It’s entitlement reform!”
House Speaker Paul Ryan has touted his plan as the “most significant entitlement reform in more than 50 years.”
Well, if by entitlement reform he means “creating a different, new entitlement” … then, sure. But that’s not what limited-government conservatives were hoping for (and promised, countless times) from a unified Republican government.
House leadership’s plan creates a new entitlement program through the bill’s tax credits, one which flows primarily to the wealthy and upper-middle class.
Furthermore, most of the ameliorating provisions of this proposed reformicon baptism are slated to happen by 2020, long after the 2018 election (which won’t bode well for the rest of those proposed replacement phases).
Finally, the American Health Care Act grandfathers Obamacare’s Medicaid expansion in. It leaves enrollment open for two more years – perversely incentivizing states to further expand it – and throws $10 billion to the states that never expanded Medicaid (which, in itself, means MORE entitlements and GREATER insolvency … all with a big, fat elephant sticker on them).
So, if “entitlement reform” really means “GOP-brand, big-government boondoggle,” then yes, this is the most significant “entitlement reform” in decades.
4) “This is just the first act; let it play out!”
This is a popular one. On his Wednesday morning radio show, Hugh Hewitt chided “diehard” conservatives opposed to the bill’s provisions, arguing that leadership’s process is akin to a five-act play that is still developing and must be viewed in full to properly appreciate.
There is some truth to that claim and analogy, even if current requests for blind trust sound an awful lot like “having to pass RINOcare to find out what’s in it.” Even the conservative repeal plan recognizes that any health insurance reform needs to happen in phases, thanks to budget reconciliation, the imposing regulatory regime, and the obstructionist Senate Democrats who will filibuster any changes to their failed law simply out of spite.
But the problem isn’t the number of acts or the length of the play; the problem is what kind of stage is being set.
Whether on stage or screen, you can usually get a sense of what you’re watching by the first act. If you’re watching a classic (as all conservatives ought, at least from time to time), then you should know what’s going on by the time the chorus is over.
It matters very little what kinds of tweaks can be made to a legislative vehicle if that vehicle retains the most problematic aspects of Obamacare in the first place — the regulations and entitlements.
Put simply, this isn’t the show the American people opted for in November. They bought tickets for “The Good, the Bad, and the Ugly” and are instead watching the opening scene to “Hairspray.” Sure, they’re both movies, but the latter wasn’t listed on the theater marquee.
Likewise, Paul Ryan’s is a health care plan, but not the kind he and his party promised.
5) “Don’t let the perfect be the enemy of the good”
Ah yes, we must compromise in order to get anything across the finish line. The Wall Street Journal’s editorial board said just about as much with their recent op-ed, “A Historic Health-Care Moment.”
“Republicans have a limited window for repeal and replace, and this is a once-in-a-generation opportunity,” writes the newspaper. “Democrats understand this, even if some conservatives don’t.” Yes, the WSJ correctly asserts that the GOP did promise a replacement package, but why are mere tweaks to the original system the “only game in town”?
It’s not as if Republicans have majorities in both houses and were already planning an “arm-breaking” whip operation in the Senate. If they’re willing to go that hard on Obamacare-lite, what in the world is wrong with going through with the full repeal they ran and won on?
And further, opposition to the GOP bill as written is not making the perfect (a true free-market health care system) the enemy of the good (sensible reforms that move in that direction). The Republican plan is bad because it keeps the core of Obamacare in place. (And Obamacare is bad.)
6) “You know it’s a good bill because the Democrats hate it”
Is Democratic posturing now the rule by which we measure good policy and principle?
Of course the Democrats hate it. Even if it were closer to Obamacare than it actually already is, they would “hate” it. Even if Ryan and Pres. Trump proposed single-payer Medicare-for-all, they would fight it, because Trump and the GOP’s name is on it. This is what happens when you treat every policy debate as a Manichean political life-or-death struggle, as the progressive movement has done for 100 years.
Further, it’s personal for Democratic leadership. Rep. Nancy Pelosi, D-Calif. (F, 10%) is desperately trying to preserve the “legacy” of the law she and others foisted on the American people eight years ago, as Politico pointed out this morning.
If anything, the Democrats are overreaching in their opposition. Were they to do everything they can to make sure this bill passes, it would make it easier for them to pull the system even further to the left once the GOP’s own death spiral reaches its natural conclusion (a collapse of the health insurance market).
The chief conservative complaint against the American Health Care Act is that the Republican Party didn’t keep its promise to fully repeal Obamacare. It’s not that Republicans didn’t put everything conservatives wanted into this bill; it is that it leaves enough of the current system in place to continue and exacerbate its problems. Again — a far cry from what the GOP ran on the past four election cycles.
If this bill is truly open for debate, deliberation, negotiation – as DHS Secretary Tom Price said Tuesday – it should be negotiated toward the kinds of market principles that will actually lower costs, improve coverage, and expand availability. (Here are a few ways to do that.)
If the Republican Party wants conservative support for their plan, if they are truly serious about correcting the failures that helped elect them, then this “opening bid” has a long way to go.
Editor's note: This piece has been updated to correct typographical errors.