Politics & Policy

On Obamacare, Don’t Rush and Don’t Give Up

Paul Ryan walks to a news conference (Reuters: Jonathan Ernst)

We’ll admit that the progress House Republicans are making on health care is well-disguised, but it is progress. The left-most House Republicans have mostly been persuaded to support an important structural reform of Medicaid. The right-most ones have mostly learned to live with tax credits to allow people who don’t benefit from Medicare, Medicaid, or the tax break for employer-provided health coverage to buy health insurance too. The party leadership has slowed down its timetable for repeal and replacement of Obamacare, even if that slowdown has come under duress and the pace is still unrealistically fast.

House Republicans seem to be too divided still to pass a bill, but the remaining distance ought to be bridgeable. What’s more, a number of Republicans are talking up an idea that might accomplish that task.

The Republicans who dissented from the House leadership’s bill from the right did so for two principal reasons: They did not think it repealed and replaced enough of Obamacare, and as a result they did not think it did enough to bring premiums down. The Republicans who dissented from the left, meanwhile, did so mostly because they worried that the bill would leave too few Americans with health insurance.

The idea that the House Republicans are now considering would allow states to apply for waivers from Obamacare regulations, and direct the secretary of Health and Human Services to grant the waivers if the states show that their plans would have a positive effect on coverage. That ought to be possible: Even the Congressional Budget Office, as biased as it is toward government-centric solutions to health-care problems, has said that eliminating Obamacare regulations would increase coverage by making it more affordable. The waivers would be a way for House Republicans to address the concerns of the party’s left and right simultaneously. As Yuval Levin explains today, the House Freedom Caucus would get a bit of what it wants by demonstrating that the moderates would get a bit of what they want.

As Levin also explains, whether this idea can be made to work depends on the details. It is far from a perfect policy. States that used the waivers would inevitably end up subsidizing states that didn’t: The waiver states would have lower premiums and therefore less federal aid. (The same dynamic already applies in the case of Medicaid: States that expanded it get transfers from states that didn’t.)

But waivers would move us toward a health-insurance system in which premiums were lower, private coverage was more widespread, and the federal government played a smaller role. The chief obstacle to agreement among House Republicans on this point, it seems to us, is that too many of them are tired of negotiating with one another about health care. We have two pieces of advice. First: Take a breather before resuming talks. Second: Pursue your interests instead of your grievances.



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