Just over a week has passed since House Republicans unveiled their health-care bill, and some in the GOP are already wavering. Yes, passing the bill to repeal and replace ObamaCare will cause political problems—but not doing so will create far bigger ones. Failure would demonstrate that Republicans don’t keep their promises and can’t govern. It would gravely wound the new administration.
The Congressional Budget Office estimated that enacting the House bill would reduce the deficit by $337 billion over a decade, lower insurance premiums by 10%, and stabilize the individual insurance market. Here’s the rub: The CBO also projects that 14 million more people would be uninsured next year—almost entirely the result of delivering on the promise to repeal the individual mandate’s penalties.
But remember that the CBO has a lousy forecasting record. In 2013 it projected that 26 million people would be enrolled in ObamaCare’s exchanges by now. The actual number is 10 million. Before the passage of the 2003 Medicare Prescription Drug Benefit, the CBO said it would cost $394 billion over a decade. Actual expenditures were roughly 40% less. The CBO has a tendency to underestimate the benefits of market forces.
Yet its troubling headline number for the House GOP bill has still made some Republicans wary. A few are calling for Congress instead to pass the ObamaCare repeal bill President Obama vetoed in January 2016.
That measure contained no replacement for ObamaCare, which was fine for making a political statement. But now the GOP is the governing party. Dumping 20 million Americans off the Medicaid rolls and insurance exchanges without offering alternative reforms would be a disaster.
Skeptical Republicans counter that they could repeal ObamaCare under the Senate’s reconciliation process, which requires only 51 votes, and then work on a separate replacement bill. When Democrats block that replacement, they can be blamed for the outcome. Another idea is to do nothing and simply let ObamaCare continue to collapse—and then to blame Democrats.
Neither plan works. Repeal without replacement would leave Republicans in charge of a crippled health-care system. Pinning the blame for ObamaCare’s collapse on Democrats won’t hold up, since the GOP controls the White House, the Senate and the House.
The answer is for Republicans to legislate—that is, to adjust the House bill, as it winds through Congress, in ways that will win enough support for passage.
The bill is already the result of a long, open deliberation. House Republicans began discussing their approach to “repeal and replace” in late 2015. Last June they endorsed principles in their “Better Way” agenda. Then the legislation was written by the requisite committees, not imposed from above.
The idea that only critics of the plan are true conservatives is ridiculous: Two House committees recently passed the bill on party-line votes, meaning it received support from all of the committee members who belong to the Freedom Caucus and the Republican Study Committee.
Republican critics of the bill have an obligation to offer, in good faith, real suggestions to improve it. Those backing the legislation should listen sincerely and be open to reasonable changes. President Trump and his secretary of health and human services, Tom Price, need to try to narrow the difference between the two sides.
Whatever improvements are made must fit within reconciliation’s framework, which allows only for the passage of measures that change spending and taxes contained in existing law.
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Popular GOP proposals that don’t fit the reconciliation requirements—like allowing the sale of health insurance across state lines or reforming medical liability—will have to wait for another day.
The process will have ups and downs, but frivolous complaints should be dismissed. Would Rep. Jim Jordan really oppose the bill because it allows insurers to charge 30% more to people who refuse to get coverage until they fall ill? What about fairness for families that keep continuous coverage? Does Mr. Jordan next plan on ending discounts for safe drivers, nonsmokers, and homeowners with fire alarms?
Republicans need to understand that their party’s interest lies in getting things done. Any intraparty differences pale in comparison to their disagreements with the other side. This young GOP government is facing its biggest test so far—and it remains to be seen if all this drama’s actors are up to their responsibilities. As Sen. Phil Gramm used to say, “You can lead or protest, but you can’t do both.” My advice? Lead.