Moderate Republicans campaigned for years on repealing and replacing Obamacare, but a few of them balked at the first opportunity to do it. A few conservative Republicans refused to go along with health legislation that fell short of repeal, even if it reduced Obamacare’s spending, taxes, and regulation. So now Senate Republicans are short of a majority for their health bill, and wondering what to do next.
We think both camps of no votes have erred, although the conservatives have done so more defensibly. They wanted to keep their party to its promise, and rightly observe that a more deregulatory bill would do more to reduce premiums. We also think that the process by which the bill was advanced — with no actual sponsors making the case for it and defending it from misrepresentation, and with a palpable desire to get it done quickly — has made it harder to pass. That said, it’s hard to defend the objecting Republicans’ failure even to allow a bill that most of their colleagues in the party supported to get a debate on the floor.
The question now is what to do next. Senate majority leader Mitch McConnell says that Republicans will now consider the bill they sent President Obama in 2015. It would repeal Obamacare’s taxes and spending, effective a few years from now. They say that would give Republicans time to come up with a viable bill.
It is a terrible strategy. It would require moderates to vote for a bill that involved a greater reduction in the insurance rolls than the one they just rejected. It would require conservatives to vote for a bill that did less to relax Obamacare’s regulations — more precisely, that did nothing — than the one they just killed. And it would be premised on the prospect of a Republican agreement on replacement that they would have just quit trying to reach.
There is an alternative, if not a very satisfying one. Republicans seem to be able to achieve near-unity on ending the individual mandate, allowing insurers to offer discounts for younger people, protecting taxpayers from having to subsidize abortion coverage, and giving states some freedom to relax regulations. They should work for legislation that achieves these goals and includes as much Medicaid reform as 50 senators are prepared to tolerate.
Republicans should not claim that such legislation would repeal and replace Obamacare, since it would not, and should make it clear that additional legislation will be needed in the future. The conservative holdouts should be prepared to judge this limited legislation based on whether it gives people more freedom to choose the health insurance they want, not on whether it does everything for which Republicans have been campaigning over the last seven years.
Whether more taxpayer money should be given to insurance companies to stabilize Obamacare’s markets, as Democrats will surely demand, should be left to another piece of legislation. Republicans should be open to passing it, given the continuation of Obamacare, but only in return for more reforms.
It has become painfully clear that Republicans do not have sufficient consensus to move us definitively away from the Obamacare model of health policy. That frustrating fact should not be an excuse for accomplishing nothing.