They should listen to Jim Capretta. Over the weekend he argued that the Republican governors are being foolish to negotiate individual deals with the Obama administration over Medicaid expansion. They would have more leverage if they stuck together as a group and agreed to expand coverage on the condition that the program be reformed for all states — and not through waivers that can be withdrawn but through new laws that could pass with the support of the administration and Republicans and would not be easily repealed. Instead of 50 little deals, one big one: a lot more freedom for state governments in return for a cap on spending per person. In particular, states should be free to let beneficiaries choose their own coverage provider with their share of Medicaid money.
In the new issue of National Review, Yuval Levin and I make the case that repealing and replacing Obamacare isn’t a pipe dream: After reviewing the alternatives, it’s the only practical way forward for conservatives. But that replacement may have to occur in pieces, and laying the groundwork for a replacement will require conservative politicians to outline their own approaches to improving government policy on health care. The administration seems desperate to get state governments to expand Medicaid coverage. Using that desperation to force real changes to Obamacare could be an important step toward its replacement.
Paging Bobby Jindal?