Politics & Policy

Putting Repeal First

Does Romney have the credibility to press the case for abolishing Obamacare?

After another strong debate performance on Thursday night, Mitt Romney is now the Republican frontrunner. He has consistently been the most prepared, articulate, and presidential of the leading candidates, and he increasingly looks like the best bet from among the current field to defeat President Obama. But the upcoming election isn’t just about beating Obama, as important as that is. It’s also about electing someone who will sweep away his statist agenda before it takes root.

The other leading Republican candidates have left little doubt about the strength of their commitment to repealing the centerpiece of that agenda: Obamacare. Rick Perry says, “The first thing that the new president, and the new Congress, needs to do is abolish that — is repeal Obamacare,” which Perry calls “the greatest intrusion on individual freedom in a generation.” Michele Bachmann declares point-blank, “My number one priority is to repeal Obamacare.” And Ron Paul, who calls Obamacare “monstrous,” says, “I want to repeal the whole government” — so it seems a safe bet that he’d also be willing to push hard for the repeal of President Obama’s signature legislation.

Unfortunately, the former Massachusetts governor’s own signature legislation seems to be contributing to his reluctance to put repeal front and center. Romney, of course, spearheaded the passage of the health-care legislation commonly known as Romneycare, whose similarities to Obamacare have been regularly noted by those on both sides of the political aisle. Romney is clearly for repeal, which puts him on the opposite side of the Obamacare canyon from Obama. But his efforts as governor of the Bay State seem to be limiting not only his willingness to prioritize repeal, but also his ability to make a persuasive case for its necessity.

Take Romney’s 59-point, 160-page economic plan. Romney summarizes his 59 policy proposals in a total of 45 separate sections (a few related proposals are combined). Of these, the section on repealing Obamacare (proposal #8) is by far the shortest, spanning just three sentences. Even this brief call for “full repeal,” however, is arguably an improvement over last year, when Romney’s “Prescription for Repeal” effort, which he ran through his political-action committee, backed those who would repeal “the worst aspects of Obamacare.”

In the first 30 pages of Romney’s economic plan, “spending” is mentioned 16 times, “tax” or “taxes” 18 times, and “regulation” or “regulations” 16 times. Repealing Obamacare would seem to be a crucial component of cutting spending, lowering taxes, and reducing the regulatory burden on Americans. Yet in those first 30 pages, the word “repeal” never appears. In the entire document, it appears just four times in connection with Obamacare.

Most telling is Romney’s list of “Day One” legislative initiatives. Seven of Romney’s 59 proposals make the cut as legislation to be proposed on Day One, but repealing Obamacare isn’t among them. Here are examples of bills that Romney prioritizes over legislation to repeal Obamacare:

• “The Open Markets Act,” which “implements the Colombia, Panama, and South Korea Free Trade Agreements”;

• “The Domestic Energy Act,” which “directs the Department of the Interior to undertake a comprehensive survey of American energy reserves in partnership with exploration companies and initiates leasing in all areas currently approved for exploration”; and

• “The Retraining Reform Act,” which “consolidates the sprawl of federal retraining programs and returns funding and responsibility for these programs to the states.”

Romney says he would ask Congress to take action on each of these proposals within 30 days. But the only thing that he says he’d do about Obamacare during that period is “Direct the Secretary of Health and Human Services and all relevant federal officials to return the maximum possible authority to the states to innovate and design health care solutions that work best for them.” This is the 50-state waiver that, during the debates, Romney has repeatedly promised to issue — so as to free the state governments, if not the individual citizens living under them, from the burdens of Obamacare.

The problem with issuing such a waiver is that it wouldn’t do a thing to wipe Obamacare off the books. Even worse, by temporarily waiving some of Obamacare’s mandates, it might well make the overhaul seem somewhat less objectionable — which is why the Obama administration has also been fond of issuing Obamacare waivers.

A 50-state waiver would not purge any of the three core elements of the overhaul: It wouldn’t eliminate Obamacare’s individual mandate, which would require essentially every American to buy government-approved health insurance under penalty of law. It wouldn’t eliminate Obamacare’s massive taxpayer-funded exchange subsidies or its plentiful incentives for companies to dump their employees into these exchanges at taxpayer expense. And it wouldn’t eliminate Obamacare’s colossal expansion of Medicaid, the government-run health-care program for the poor, which would be extended — along with its notoriously subpar patient care and provider compensation — into parts of the middle class.

Why wouldn’t Romney promise to submit a repeal bill on Day One? It’s hard to say for sure, but perhaps he’s being influenced by the fact that his own Massachusetts health-care law includes these same three core features: an individual mandate; taxpayer-funded exchange subsidies (codifying the principle that middle-class Americans shouldn’t be expected to provide their own health care); and an expansion of Medicaid at federal taxpayers’ expense.

It has long been an open question whether Romney would make repeal a centerpiece of a general-election campaign, thereby building momentum for its passage. Republicans will, after all, have to get a repeal bill through a Senate that includes plenty of Democrats. If Obama gets sent packing largely because of Obamacare, then, even if just out of self-preservation, Democratic senators are unlikely to successfully filibuster repeal. But if Obama loses in a manner that’s overwhelmingly attributable to the economy, with barely a peep uttered by the Republican nominee about repeal, a different story may well play out in the Senate. This could leave Republicans with no choice but to go down the reconciliation path, which would not be as conventional, as clean, or as emphatic.

All of this, of course, would affect far more than just Romney. Philip Klein writes that “the Massachusetts health care plan is not only toxic to Mitt Romney’s presidential candidacy, but it could prove toxic to the entire Republican party.” Klein adds, “If Romney is excused for crafting and signing the Massachusetts health care plan, it significantly undermines the case against Obamacare and weakens the effort to repeal it.”

It’s one thing for Romney’s fellow Republicans to forgive Romneycare; it’s quite another to try to justify it publicly. The party cannot very well defend Romneycare and attack Obamacare simultaneously. Indeed, in the most recent debate, Romney, in his defense of his own health-care legislation, sounded like he was providing a defense of Obamacare, with his repeated invocation of “private, market-based insurance” and his insistence that people who were already insured could keep their plans.

As we approach 2012, repeal is the single most important issue for most Republicans, and it enjoys the clear support of Americans generally. Voters want the Republican presidential nominee to show leadership on this issue. Moreover, they don’t just want repeal; they want a replacement — and it’s a lot easier to champion a replacement that’s consistent with limited government and liberty if you haven’t been trying to defend something that’s not.

The challenge for Romney is to show that he’s the right person to provide such leadership. Here’s how he can strengthen his case:

Instead of trying to defend Romneycare on the merits, he should note that Massachusetts is a state in which Obama not only swept all ten congressional districts but won each by double digits. He should emphasize that he was giving the people of Massachusetts exactly what they wanted, but that he knows that most Americans wouldn’t want that in their state — and certainly don’t want it imposed upon them nationally. He should leave it at that. If he says that the people of Massachusetts wanted it and it was a good idea (and here’s why . . .), then it no longer sounds like it’s just liberal Massachusetts that embraces such government overreach.

Beyond this, he should admit that his efforts failed to cut costs (a point he essentially grants in his book) and talk about how he’s learned from that experience. He should discuss how it taught him that the right way to reform health care is to cut costs, which in turn makes health care available to more people — rather than to make health care available to more people, which in turn only raises costs. He’s already ventured somewhat onto this cost-cutting track, saying that he would promote the use of health savings accounts, which would give people skin in the game and help make our health-care system one in which people care about the prices of services — and in which providers therefore care about providing good value. In addition to highlighting his hard-won expertise, this would show that he — unlike Obama — can learn from his mistakes.

At the very least, he should make it crystal clear that he would push repeal — not waivers — on Day One.

— Jeffrey H. Anderson is a senior fellow in health-care studies at the Pacific Research Institute and was the senior speechwriter at the U.S. Department of Health and Human Services during Pres. George W. Bush’s second term.


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