The House Republican leadership and their supporters are doing a really bad job of trying to convince reluctant Republicans to vote for their health-care plan. Their arguments pretty much revolve around these three points: 1) We have to pass this bill, we have no choice; 2) this plan cuts taxes, and we love tax cuts; and 3) if you don’t vote for this bill, you may lose your seat in 2018.
As he did during the presidential election, Speaker Ryan likes to say that tomorrow’s vote is “a binary choice,” and that this bill is “the closest we will ever get to repealing and replacing Obamacare.” I disagree. Voting for a bad bill isn’t the only choice members of Congress have and neither is it better to implement bad policies than to do nothing. For one thing, if this is the best that leadership can deliver on health-care reform, then it is a very sad day for the free-market movement, and it tells you a lot about those behind the bill. Anyone looking at this bill from a policy perspective can see that it is a poorly designed replacement plan, which achieves less than Obamacare. Even after the amendments made to the bill to try to fix it, Michael Cannon of the Cato Institute rightly sums up:
These changes are cosmetic. They do not alter the fact that the CBO projects the AHCA will cause average premiums to rise by 20 percent. And they do not address the root problem of excessive health care prices.
Expanding the tax credits simply throws even more federal dollars after unaffordable care. . . .
When the House GOP leadership unveiled the American Health Care Act, I wrote that it “merely applies a new coat of paint to a building that Republicans themselves have already condemned.” All these amendments do is paint the shutters a different color. Even with these amendments, the AHCA would be worse than doing nothing.
As Washington Examiner’s Phil Klein explained well, this is not what conservative reform looks like and there are plenty of good policy reasons to oppose it. That would give a chance to Republicans to go back to drawing board and come up with an actual free-market repeal bill.
I get also very tired of hearing that it is worth supporting a bad bill because it cuts taxes. I love tax cuts as much as the next free-market person. But you know what? I love small government and good policy even more. That’s because I don’t believe that you can have one without having the other. If the tax cuts are part of a bill that gets the policy so wrong that whatever spending cuts are planned, they won’t materializing (which will create great pressure for future tax hikes), then I lose my enthusiasm for tax cuts. Republicans should try to get the policy right rather than just be happy with the plan to cut taxes.
On this point, Avik Roy adds the following:
While fixing the AHCA’s treatment of the low-income near-elderly proved to be too heavy of a lift for the House, the Manager’s Amendment does find the time to cut taxes further for upper-income individuals, by pushing forward the repeal of Obamacare taxes to include the 2017 tax year.
My Forbes colleague Ryan Ellis is pleased by these tax cuts, but it’s curious that extending tax cuts was a higher priority for the House than addressing the fact that the bill will make insurance unaffordable for millions of Americans.
The “vote for Obamacare repeal or else” argument is also particularly unappealing. That tells you nothing about how good the plan is, and it tells you a lot about the desperation of those pushing it. Seriously, having to resort to threats is not a sign of strength. And, by the way, what is the rush? This plan is not rolling back Medicaid expansion and it’s not really kicking in until a few years down the road. Republicans should have more time then to put together a good plan, or at least a plan as good as the one they voted for last year to fully repeal Obamacare. On that note, if leadership wanted to make sure they would get the support of the members of their party, shouldn’t they have circulated the plan long before they released it in order to get the input of scholars and members? Yes, they should have. But they didn’t.
Finally, I see that Peter Suderman writes on this same issue this morning. He makes this excellent point:
There is the argument, made by Speaker of the House Paul Ryan, that the bill is a prerequisite for some hypothetical future tax reform legislation. (Last night, Trump made a version of this argument as well.) It is true that passing the health care bill through the reconciliation process now would make certain aspects of the tax reform process — namely permanent large tax cuts — easier later. But that is an argument for tax reform, not for the GOP health care plan.
One area where the Republican leadership may be right is that Republicans were given an unprecedented opportunity to pass a repeal-and-replace bill and it will define them for years to come. Indeed, bad reforms will define them for many years to come.