‘Debacle” does not have to be the last word on Republican efforts to repeal and replace Obamacare. They can still improve the health-care system, reduce the power of the federal government, and make good on important campaign promises — but only if they start over on health care.
Republicans more or less fell into a losing strategy. They began by thinking they could quickly repeal Obamacare and then replace it at leisure. To their credit, they substantially modified their plan in response to criticism, attempting to do portions of both repeal and replace in one bill. But this new approach was a bad fit for the old schedule. A viable repeal-and-replace plan could not be slapped together as fast as Republicans wanted to move. Compounding the problems were Speaker Ryan’s high-handedness and President Trump’s erratic leadership.
This week’s embarrassments make it hard to see the opening that remains for Republicans. The fact is that Republicans reached a fair degree of consensus during this process. Take the House Freedom Caucus. It is being excoriated in some quarters for its inflexibility, but in fact most of its members made their peace, whatever their misgivings, with the idea of providing tax credits to help people who otherwise could not buy health insurance. They insisted only that those tax credits be coupled with deregulation to lower premiums.
House Republican leaders insisted that they would like to see more deregulation, too, but feared that the Senate parliamentarian would rule that any bill with it would be subject to a filibuster. The parliamentarian has, however, said that she has not been consulted about how much deregulation she would allow.
Cutting regulations could be key to finishing the unification of the party. The Congressional Budget Office has previously found that cutting down on Obamacare regulations would increase coverage, since it would make it possible for people to buy low-premium coverage they prefer. While some specific deregulatory measures make moderate Republicans jittery — even a careful relaxation of the rules governing pre-existing conditions would induce some queasiness — improving the coverage numbers would allay their main concern about replacing Obamacare. Expanding the tax credit for people making a little bit too much money to qualify for Medicaid could allay it more.
This basic approach would be compatible with a variety of legislative tactics. House Republicans could try to pass an aggressive bill without much regard for whether it can pass the Senate: At least they would have outlined and stood for a set of health-care policies that make sense, that offer something for conservatives and moderates, and that can serve as the basis for future action. Or they could work with the parliamentarian and with senators to see whether they could get a bill better than this week’s past the finish line.
If they went this route, Republican leaders would not spring a new bill on their followers and allies and tell them they have to vote for it posthaste. There would have to be more patient cajoling and less last-minute bullying. We know many Republicans on the Hill and inside the White House feel that they have already spent enough time on this issue. But we have no sympathy for this complaint. They have spent seven years saying they were going to replace Obamacare. They didn’t say they were going to spend a few weeks on a half-baked plan and then give up. Back to work, ladies and gentlemen.