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The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

Targeted Strikes and the Politics of Replacing Obamacare



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Elise Viebeck of The Hill reports that conservative organizations that had championed the defund strategy are increasingly open to “targeted strikes” designed to prevent the Affordable Care Act from becoming firmly entrenched:

“Whatever the fight is, we want to be involved in that fight,” said one prominent activist.

“If there is a good delay bill, I certainly wouldn’t want to sacrifice that just holding out for something else.” Republicans see an opening in the step-by-step strategy with 10 Senate Democrats, including seven who are up for reelection next year, moving to support extending the healthcare enrollment period.

Sen. Joe Manchin (D), a centrist from West Virginia, is also preparing legislation to delay the individual mandate.

The fact that conservative activists are open to piecemeal legislation is an encouraging sign. It represents a turn away from an “all-or-nothing” approach, though one would hope that “targeted strikes” are motivated primarily by a desire to protect the interests of consumers and to pave the way for conservative health reform. The next part of Viebeck’s raises an important question:

Both are notable signs of fracture among Senate Democrats, who remained in near lock-step during the shutdown battle as Republicans broke apart. Conservative groups say they’re ready to pinpoint vulnerable Dems with targeted bills and that activists are energized to elect “more Ted Cruzs” in 2014.

If Republicans elect “more Ted Cruzs” in 2014, is the congressional GOP more or less likely to coalesce around a realistic proposal for replacing Obamacare? The central dilemma for a conservative replacement agenda is that legislation that will expand access to affordable coverage through market-driven means will require more spending in some areas (e.g., a refundable credit that will help cover large numbers of people who are currently uninsured) and less spending in others (the timetable for Medicare reform, for example, might have to be moved up), and this will entail political risk.

One can imagine a scenario in which congressional Republicans unite around a serious replacement agenda, as they united under the Ryan Medicare reform proposal; but one can also imagine a scenario in which a small number of GOP lawmakers opportunistically attack a serious replacement proposal on the grounds that it is too expensive or redistributive. If our goal is to get to a market-driven, fiscally sustainable U.S. health system, a serious replacement agenda is essential; but if individual politicians choose to raise their profile at the expense of their colleagues, a replacement agenda along these lines is very vulnerable. 



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