A GOP Plan for Health Care? Don’t Bet on It

by Jonathan Strong
Republicans have ideas for health care — but probably not a unified approach anytime soon.

Is it time for the GOP to graduate from bashing Obamacare to embracing a solution of its own?

Republicans on Capitol Hill are increasingly eying the possibility, even as conservative voices push against the idea of a single, comprehensive bill.

“When do we add to our arsenal, not just attacking Obamacare, which deserves to be attacked and exposed for its own weaknesses, but when do we add to that discussion a way to resolve the health-care issues that we face in the nation?” asks Representative Mick Mulvaney of South Carolina.

In the spring, GOP whip Kevin McCarthy established a working group called the House Obamacare Accountability Project, which sources say has quietly discussed the possibility of adapting health-care principles for the party to embrace.

The group’s work complements the efforts of individual members such as Representative Tom Price of Georgia, who has championed his own health-care bill, and Republican Study Committee chairman Steve Scalise, who worked with Representative Phil Roe to craft an RSC bill the group unveiled in September.

On December 3, at the height of the HealthCare.gov failures, President Obama challenged opponents: “I will work with anybody to implement this law effectively. Now, you got good ideas? Bring ’em to me. Let’s go.”

Days later, the RSC sent its bill to the president. The group now has a clock on its website documenting the time that has elapsed without response from the president.

Mulvaney says the hardest question he gets back home when Obamacare comes up is, “well, what do the Republicans want to do about health care?” The trouble isn’t that the GOP doesn’t have ideas, he says. “We’ve got them! We all know about the bills and so forth. But we haven’t, sort of rallied behind them yet and driven that message as a party. So when do we start to do that?” he asks. But that’s easier said than done: Republicans have had difficulty agreeing on health care in the past. In April, majority leader Eric Cantor had to pull a bill to support federally funded high-risk pools, one element of some GOP plans, for lack of GOP support. The resulting headlines were brutal: Ross Douthat took the kerfuffle to lament “the Republican health policy trainwreck.” ‎Some opponents of Cantor’s proposal were simply worried that funding the program, established by Obamacare, would muddle GOP attacks on the law, but many others were primarily concerned with funding a federal health program at all.

Health-care-reform legislation at the federal level is something of a minefield for Republican officials, who run into criticisms from the right that the “conservative” solutions are creating new federal programs, increasing spending, or taking power from state governments.

Grace-Marie Turner, the president of the Galen Institute, a conservative health-care think tank, says she has been pushing GOP officials to present solutions, but not in a single, comprehensive bill that would quickly create political problems of its own.

“I actually worry conservatives play into hands of liberals if they try to get behind one bill,” she says.

As Turner sees it, a single bill to deal with the many problems of the health-care market would need to be long — reminiscent of Obamacare’s 2,000-plus pages —  cumbersome, and a good way to open Republicans to new political attacks.

Instead, she wants the GOP to rebuild trust with the public by selling the principles of conservative reform, which she outlines as choice, security, portability, and accessibility.

Any conservative reform bill, she says, has to recognize that the current health-care marketplace, even before Obamacare, doesn’t resemble the market for a normal consumer good at all, because of overwhelming government regulations and other factors. Another key issue: How to provide security for individuals with preexisting conditions, whom Obamacare now protects — high-risk pools are the traditional GOP solution to the problem.

Legislation to tackle these problems would necessarily force tough choices: One of the biggest distortions conservatives have to remove from the marketplace, experts say, is the tax exemption for employer-provided health insurance, which could make the bill an easy target for the Left.

On its face, the idea that opponents of current law or a proposed bill should have their own solution seems reasonable, but in D.C.’s trench warfare, it’s not unusual for strategic politicians to avoid giving their opponents the avenue for an attack.

At a 2012 event to celebrate her 25th year in Congress, for example, Democratic minority leader Nancy Pelosi explained that the key to defeating conservative proposals to reform Social Security was for Democrats not to embrace their own reform plan (despite the program’s disastrous finances).

Republicans are heading to a closed-door retreat at the end of the month, where Mulvaney hopes the issue will be discussed. But no matter how Obamacare goes, the GOP may not unify on an approach to health care anytime before at least 2017 — the first time they could have a chance to actually implement their ideas.

— Jonathan Strong is a political reporter for National Review Online.