What’s next for health care reform?
House Republicans are going back to the drawing board on health care — and that’s a good thing. Their failure to pass the American Health Care Act last week actually saved them from an even bigger disaster — passing a deeply flawed bill.
As conservatives of all stripes noted, not only did the bill not repeal the Affordable Care Act, it didn’t even address two key problems with Obamacare — cost and coverage. The American people are sick of seeing their premiums rise and insurance companies flee the exchanges.
In a meeting this week, House Republicans agreed to follow the adage, “if at first you don’t succeed, try, try again.” Their rhetoric is promising. Majority Whip Steve Scalise, R-La., told reporters, “We’re closer today to repealing Obamacare than we ever were before.” As Speaker Paul Ryan told a press conference, “We will repeal Obamacare — this time, without a timeline.
Let’s hope they’ve learned from their mistakes.
One thing that led to the American Health Care Act’s downfall was its development process. Written in secret, it was then rushed through in a truncated timeline that didn’t allow for the consideration or consensus-building necessary to pass a policy of this magnitude.
Ryan and his leadership team wrote the bill, then handed it to their conference as a “binary choice” — this bill, or nothing. The intervention of President Donald Trump forced House leadership to hear out those with objections, and accept certain changes — though not enough to satisfy conservatives or a broad swath of moderates needed to pass the bill.
This rushed, opaque process must not be replicated. Whatever this next bill looks like, it must be written transparently, in an open committee and floor consideration process, and with input from a majority of House members.
The majority of those now in Congress campaigned on and were elected to repeal Obamacare. Their input is a critical component of reaching consensus in the House.
The next reform bill must repeal the architecture of the Affordable Care Act. The Republican bill left large parts of the law in place. This was a policy — and a strategic — mistake.
Democrats are never going to vote to repeal the signature initiative of the last Democratic president. Recognizing this, Republicans should revive the 2015 repeal bill passed by both the House and Senate two years ago — include in it a repeal of the Affordable Care Act’s crushing regulations — and pass it using a process known as reconciliation, which needs only 51 votes.
That 2015 bill calls for a two-year window in which the law will be phased out, giving Congress time to work out bipartisan, consensus solutions to reform the health care market. No one would lose health care the day after passage.
Both parties have the same goal — to foster accessible, affordable care for all Americans. Where they differ is the means. But once the Affordable Care Act is gone, it becomes a political necessity for both parties to find areas in which to work together.
What areas should they focus on once the law has been repealed? First and foremost, reforms need to infuse market forces into healthcare. If the Affordable Care Act has taught us anything, it is how badly the government is at managing costs, competition, and access — the very things that the market manages extremely well.
At the Heritage Foundation, we’ve proposed key reforms, such as equalizing the tax treatment of health care on the employer and individual market. Now, employers can deduct the cost of covering their employees. Why shouldn’t individuals purchasing coverage get the same break?
We’ve also proposed giving individuals the same protections those in the employer group market receive. In the employer market, individuals who maintain coverage cannot be denied for a pre-existing condition, or charged higher premiums due to health status.
Rachel Bovard is the director of policy services for the Heritage Foundation.