Obamacare Triage: With Strategy This Time
Rollback and repeal are possible, but Republicans need a realistic plan.



The time has come for a coherent, multi-step strategy for rolling back Obamacare. It is not enough for conservatives to focus just on the website problems, or to wait and hope the misnamed Patient Protection and Affordable Care Act (ACA) collapses on its own. The websites will ultimately get fixed well enough to function, and the “just wait” strategy underestimates both the appeal the new entitlement may hold for many and the serious damage that is being done to the private insurance market, whose viability is the foundation of any alternative to government mandates.

Ultimately, the only way to minimize the damage Obamacare will inflict on millions of Americans and our health-care system is to gain enough seats in 2014 and 2016 to build a majority favoring repeal. Achieving that will require both better messaging and a legislative strategy that limits the harm and metastasis of this uncompassionate and malign law.

Here, as in so many other areas, conservatives should follow President Reagan’s example. He constantly spoke for all Americans and insisted accordingly on having Democrats co-sponsor legislation. That must be our goal. This issue isn’t about partisanship and scoring cheap political points; it is about restoring our freedoms and achieving good health care for all Americans.

Conservatives must advocate for ways to minimize the great harm this law does to our health sector and economy, and they must describe more effective alternatives. As was true in the welfare fight, people won’t trust us to change a broken system until we show that we care about how the present system harms people and propose better ways to help them help themselves. Opponents of ACA are the true champions of fairness, with our vision of non-coerced assistance for those who need it and of free individuals making their own choices instead of the government’s one-size-fits-all imperialism. Opponents of ACA are the ones who have compassion for the people this law hurts — not just those who in recent weeks have received cancellation notices, but the millions who will lose the insurance, doctors, choices, or price they liked, whether through mandated cancellations, breathtaking price increases, or ACA-induced job restructuring.

Legislatively, our slogan should be “Tell the truth, stop the bleeding, free Americans to find the cure.” We opposed Obamacare because we foresaw many of the problems that are now obvious and undeniable, and we need to attract bipartisan support to mitigate those problems now and set the stage for real health-care reform in the near future. Here are seven meaningful, achievable steps that will advance that goal.

1) End the congressional exemption. The top priority for anyone who is serious about minimizing the pending damage of the ACA is passing Senator David Vitter’s amendment. This would enforce Obamacare’s requirement that members of the House and Senate, and all their staffers, must buy their insurance on the exchanges, unsubsidized and without escape clauses — just as millions of Americans are now required to do. The Obama administration had provided subsidies to members of Congress and their staffs to soften the blow of large rate increases under Obamacare, and a further loophole option of declaring staff “not official,” which puts them back in the federal health program and out of the exchanges altogether; Vitter’s amendment would eliminate this special treatment.

The Vitter language is not only the embodiment of fairness and rule of law, but is important strategically: It provides the additional negotiating leverage of self-interest that will be needed to accomplish real delay. If Congress wants to keep its existing insurance for itself and its staffers, which it desperately does, achieving that would become conditional on extending the same opportunity to the rest of America.

The challenge is getting a vote. Undoing the exemption will be almost impossible for members to vote against, which is why Majority Leader Harry Reid blocked a clean vote on it in the Senate, and why too many Republicans — just as anxious as Democrats to preserve their benefits — refused to go along with GOP leadership’s efforts to bring it to a vote in the House as part of an attempted final offer during the shutdown.

(Be advised: Similar-sounding proposals that would undo the exemption for all federal employees are just a gambit — a show vote in which Republicans can vote yes, knowing that it will never pass, and Democrats have an excuse to vote no. Republicans get a campaign issue while still keeping their special treatment, at the price of forgoing the leverage in future negotiations that passage would have brought.)

The Vitter legislation is thus the litmus test for whether members genuinely want leverage that could help minimize the damage that the next three years of ACA will do. It is disturbing that leadership seems content with merely having held a vote on the issue during the continuing-resolution fight (as part of a package that failed in the Senate), giving them a good issue to use in campaigns but no change in the law.

If, in contrast, the House were to pass a clean bill, not only would it put enormous pressure on Senator Reid and his fellow Democrats to vote accordingly, but it would lower the threshold of votes needed in the Senate from 60 to a simple majority, which is actually doable. If we want serious triage on Obamacare, making it absolutely clear that a show vote on Vitter isn’t enough will be key.