House Republicans should vote for the latest version of the health-care bill. We say so even though we have criticized previous versions and the process that led to this one, and even though we still have serious reservations. We say it because the bill has moved in the right direction, and because in our judgment passage through the House now considerably raises the likelihood that we will see improvements in health policy this year.
The bill as it stands would abolish Obamacare’s fines on people without health insurance, reduce taxes and spending, reform Medicaid by moving it closer to federalist principles, and open the door to deregulation in states that choose to pursue it. It would thus move us closer to a system in which people would be able to buy renewable catastrophic coverage, and without subjecting such policies to disadvantages compared with other types of insurance.
Some House Republicans are concerned that the bill might undermine protections for people with pre-existing conditions because, under some circumstances, it would let states allow insurers to consider people’s health status when pricing coverage. But those circumstances should ease their concerns. Insurers could consider health status only in the case of people who have not been continuously insured, and even then could consider health status only for each person for a one-year period, and only in states that offer such people access to high-risk pools. The point of that provision is to give people an incentive to buy coverage when they’re healthy and remain continuously insured without an individual mandate. It is not intended to leave people with pre-existing conditions unprotected, and it takes some care to avoid doing that.
Senators should pursue two complementary objectives in amending the bill if it comes before them: lowering premiums through further deregulation and promoting broad coverage levels through reforms (and if necessary augmentations) to the bill’s subsidy structure. The House has based its work on some assumptions about what the Senate’s procedural rules will ultimately bear. Senators will be better positioned to test those assumptions. It may turn out, given Senate rules, that the right approach would be simply to send money to the states with a directive to use it as they see fit to ensure that people without access to Medicare, Medicaid, and employer-provided insurance have coverage. Additionally, senators should take the strongest possible measures to keep government subsidies from benefiting abortionists.
We’re not going to give up on health-care reform if this bill fails in the House. Republicans should be under no illusion that either passage or failure will make this issue go away: They are going to continue to face conflicting pressures from different groups of voters for years to come. They need to find a way to pull the health-care system back from the centralizing path on which Obamacare put it. At the moment, House passage of this bill looks like the most plausible way.