The Top Ten Health-Care Bills for 2013
New tactics are needed to make the case against Obamacare.

"Hands Off My Health Care" rally at Capitol Hill, March 27, 2012.


James C. Capretta

Last year, the two best opportunities to stop Obamacare before it got implemented were missed. First, Chief Justice John Roberts bent over backwards to find the law’s individual mandate to be a constitutional tax on the uninsured. Then, the voters decided they preferred another term for President Obama over a Romney administration.

As a consequence, Obamacare isn’t going to be wiped off the federal books in the next few years.

This reality has important implications for congressional tactics. In the previous two years, everything that was done in the Republican-controlled House of Representatives was aimed at building momentum for full repeal in the event Romney won the White House. Since that didn’t happen, other tactics are necessary.

Congressional opponents of Obamacare need to do two things in the months ahead. First, they need to pursue legislation that can contain and minimize Obamacare so that a future president and Congress can still change direction if they choose to do so. Second, Congress needs to continue to cultivate public opposition to Obamacare by highlighting strong bipartisan opposition to its worst features. Bipartisan bills to repeal or substantially amend the law are especially important because they will sow disunity among Democrats and create openings for future revision.

The following is a top-ten list of health-care bills that could help Congress pursue these goals (although there are, of course, many other good ideas that would also help the cause). Each of these items could be pursued as stand-alone bills on the House floor.

1. Delay
The Obama administration chose to delay many of the most controversial implementing rules of Obamacare during 2012 to avoid stirring up opposition to the president during the election year. That decision has now put everything behind schedule. Moreover, a majority of states have decided (as was their right) not to build the state exchanges envisioned in the law, leaving the task to the federal government. And there’s no direct appropriation available to the federal government for this task. So it’s quite clear that implementing the law by January 2014 will create significant and unnecessary chaos in the insurance marketplace. Republicans should seize the opportunity this state of affairs provides and push for a delay of the law’s implementation. The administration will of course vigorously oppose any suggestion of delay, but many employers, states, and health-sector participants would welcome it.

2. IPAB Repeal
The Independent Payment Advisory Board (IPAB) is the poster child of the Obama vision for cost control. The new agency, composed of 15 unelected “experts,” is supposed to enforce a new cap on Medicare spending growth, without any political accountability to the program’s beneficiaries. Moreover, the only tools IPAB can use are further reductions in what Medicare pays for the provision of services to patients. But these kinds of price controls drive suppliers out of the program and leave beneficiaries on waiting lists for services. A clean IPAB-repeal bill — with no other poison pills attached to it — is sure to draw significant Democratic support. The GOP should ensure such a vote occurs soon.

3. Scale Back Premium-Credit Subsidies
Obamacare has set in motion the largest entitlement expansion in a generation. In theory, the new law entitles all Americans with incomes between 133 percent and 400 percent of the poverty line to new subsidies for health insurance. According to the Census Bureau, there are 110 million Americans under age 65 in that income range. Once the subsidies are in place, the pressure in Congress will be to expand benefits for this large new cohort of entitled voters. President Obama has often said that Massachusetts was the model for the national law. Well, Massachusetts cut off its new entitlement at 300 percent of the poverty line. The House should advance a bill to do the same with Obamacare before the entitlement goes into effect.

4. Repeal the Uninsured Tax (the Individual Mandate)
The chief justice ruled that the individual mandate could survive as a constitutional tax on those who fail to buy government-approved insurance. But that didn’t make it any more popular. Indeed, now that it is clearly just a tax on the uninsured, it will be more unpopular than ever. Ironically, according to the Congressional Budget Office, a repeal of this tax would reduce the deficit by nearly $300 billion over a decade as it would lead to fewer participants in the Obamacare entitlement expansion.