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Health-Care-Reform Reform


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The White House is so very confident in the goodness of Obamacare that it is putting a large part of it on hold until after the midterm elections. The GOP should not underestimate the significance of this development. It is an excellent opportunity for congressional Republicans to extend an olive branch to the Obama administration by codifying that delay in law — and making it permanent.

The administration has announced that it will delay the enforcement of the employer mandate, one of the most disruptive provisions of a generally expensive and disruptive program, until after the 2014 elections. The weak economy and the vagaries of the electoral calendar have Democrats afraid that they will see their Senate numbers diminished in the next election, and possibly even lose control of the chamber. One of the reasons for the weak economy is the Patient Protection and Affordable Care Act, a.k.a. Obamacare, the substance and implementation of which has complicated business decisions touching everything from long-term investments to hiring to the number of hours worked by part-time employees. The law specifies that firms with 50 or more workers are subject to the mandate, so, predictably, small companies are forgoing new hires to stay under that threshold. The law also establishes 30 hours per week as the upper limit for “part-time” workers, so firms are cutting back on hours to minimize their exposure to the law’s penalties.

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It is not entirely clear that the law empowers the administration to impose this delay on its own — though when has the law ever stood between the Obama administration and expedience? — but the fact that the White House apparently believes it has the power to do so highlights a core problem with Obamacare: The legislation does not create a health-care program, but merely instructs the federal bureaucracy to create a health-care program. Obamacare is not a legislative enterprise but a regulatory one, with the most important decisions and determinations entrusted to unelected administrators and political appointees. As the IRS scandal so dramatically illustrates, federal agencies have political agendas of their own, and their decision-making processes can range from the arbitrary to the malicious.

The costs, administrative burdens, and restrictions associated with Obamacare inevitably must enter into a great many business decisions, both in the long term and in the present. The White House’s keystone program, and its herky-jerky execution of it, are key sources of economic instability.

Which brings up an important point: The Obama administration’s most important pieces of economic policy are not explicitly economic measures but its health-care and energy agendas, which together constitute the federal regimentation of a large and critical swath of the U.S. economy. While hamstringing the oil-and-gas renaissance would impose serious long-term costs on the economy, the costs of Obamacare are being felt in the here and now, which is why the administration is stalling the implementation of what it considers its most important achievement.

In that economic and political context, congressional Republicans have an opportunity to act — if they will take it. But a return to the status quo ante is not a proper health-care agenda. Republicans made a serious error in the health-care debate by failing to truly appreciate the anxiety that was already being produced by what they kept insisting was “the best health-care system in the world.” Americans are unhappy with Obamacare, but they also were unhappy with the system that preceded it, and not without reason. The linkage of health insurance with employment means that the priorities of consumers take a back seat to those of employers and insurers, and makes the consequences of losing one’s job potentially ruinous, far beyond the impact of lost income. That left many Americans vulnerable and dissatisfied. The debate about health care is at least as much about the security of coverage as about its cost.

Obamacare will of course make that system worse, keeping the most dysfunctional elements of the old system and putting them under the management of an expensive and politically oriented bureaucracy. Republicans have conducted dozens of symbolic votes to repeal Obamacare, but what they have not done, despite the best efforts of Representative Tom Price (R., Ga.) and others, is make any real progress on a health-care agenda of their own, one that mitigates both the costs and the anxiety associated with health care by putting consumers rather than their employers and the government in charge of their own coverage. Subsidizing health care for the poor and for those with preexisting medical conditions is a task that would be rendered considerably more tractable by the emergence of a functional national consumer market for health insurance, the creation of which should be the top priority of Republican health-care efforts. Whether that is accomplished by the more satisfying route of repealing Obamacare all at once or by the less satisfying route of doing it one piece at a time is less important than that it simply be done.

Republicans can begin by endorsing the White House’s delay of the employer mandate — and making that delay permanent. The naked political calculation behind the administration’s stalling is an invitation to action: If the mandate is really good for the country, surely it is good for the country before the 2014 election as well as after it. If the administration is afraid of the economic consequences of the mandate — and it should be — then surely we should worry about its effects after the election as well as before. But knocking over the tottering Jenga tower of Obamacare is not sufficient: Republicans have to begin building something to take its place. Harry Reid and his caucus stand in the way of that today, but if Senate Democrats want to make blocking reform of the health-care mess their hill to die on, Republicans should stand ready to assist them.



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