Congressional Republicans should stop calling their health-care bills a repeal of Obamacare. The House bill is not one — it keeps Obamacare’s regulatory heart — and the Senate bill is even less of one now that it has been amended to keep some of Obamacare’s most economically destructive tax increases. And because the bill is not a real repeal, people will face some combination of higher premiums, co-payments, and deductibles than they otherwise would. Moderate Republicans, who said for years that they wanted to repeal Obamacare but apparently never thought through what repeal would entail, are mostly to blame for these disappointing facts. Republicans have failed to make good on their promises.
But there are two further questions that conservatives should ask about the legislation. The first is whether the bill, disappointing as it is, represents a substantial improvement over the status quo. The second is whether modifying the bill in a House–Senate conference would be likely to yield better results than letting it die. In both cases, we think the answer is yes.
The bill cuts taxes, restrains spending, and — courtesy of the tireless efforts of Senators Ted Cruz and Mike Lee — modestly deregulates. It ends Obamacare’s obnoxious fines on people who go without health insurance. It would be likely to yield lower premiums than keeping Obamacare as it is — although supporters of the bill should be careful not to promise too much on this front. Its Medicaid reforms would control the growth of that program, give states a stronger incentive to police fraud and seek efficiency, equalize funding between Medicaid’s new beneficiaries and its poorer traditional ones, and provide some help for people who wish to move from Medicaid to private insurance. It could produce a larger individual insurance market by attracting a greater number of young, healthy people who voluntarily choose to enter it. The bill blocks federal funding for Planned Parenthood, the nation’s largest abortionist, and includes a provision to prevent taxpayer subsidies for abortion coverage.
The current draft of the Senate bill should not be the last word. Republicans should restore as many of the tax cuts to the bill as possible. The bill should be more aggressive in helping those who wish to leave Medicaid. Pre-funded health savings accounts would allow them to pay the deductibles for catastrophic policies while also retaining incentives to control costs.
We would, however, recommend that conservative senators vote for the bill — and that all Republicans do a better job of defending it from the Left’s hysterical attacks. The bill would not “throw 22 million people off insurance,” the Congressional Budget Office has not said so, and Democrats and reporters who claim otherwise are telling untruths. The bulk of the CBO’s 22 million would voluntarily drop insurance if not threatened with fines. Obamacare hasn’t been shown to have saved any lives (mortality trends since its implementation are not especially encouraging), and there is little reason to expect a partial repeal of it to endanger any. Nothing in the bill requires any state to roll back eligibility for Medicaid. And so on.
Voting for a bill that has been so demonized and distorted would pose a political risk for senators — especially since so few conservatives are truly enthusiastic about the bill and since Republicans would become part-owners of a frequently maddening health-care status quo. But the alternatives look worse. Republicans would probably have to pass an insurance-company bailout to keep Obamacare’s exchanges going if they fail to pass this bill; and some measure of political responsibility for the health-care system is inevitable given Republicans’ control of Congress and the White House.
They could be using all that power more effectively to foster a functional health-insurance market with a more appropriately modest role for the federal government. But they are taking significant steps to advance that goal, and conservatives should accordingly support them.