Obamacare Triage: With Strategy This Time • National Review Online
The time has come for a coherent, multi-step strategy for rolling back Obamacare. It is not enough for conservatives to focus just on the website problems, or to wait and hope the misnamed Patient Protection and Affordable Care Act (ACA) collapses on its own. The websites will ultimately get fixed well enough to function, and the “just wait” strategy underestimates both the appeal the new entitlement may hold for many and the serious damage that is being done to the private insurance market, whose viability is the foundation of any alternative to government mandates.
Ultimately, the only way to minimize the damage Obamacare will inflict on millions of Americans and our health-care system is to gain enough seats in 2014 and 2016 to build a majority favoring repeal. Achieving that will require both better messaging and a legislative strategy that limits the harm and metastasis of this uncompassionate and malign law.
Here, as in so many other areas, conservatives should follow President Reagan’s example. He constantly spoke for all Americans and insisted accordingly on having Democrats co-sponsor legislation. That must be our goal. This issue isn’t about partisanship and scoring cheap political points; it is about restoring our freedoms and achieving good health care for all Americans.
Conservatives must advocate for ways to minimize the great harm this law does to our health sector and economy, and they must describe more effective alternatives. As was true in the welfare fight, people won’t trust us to change a broken system until we show that we care about how the present system harms people and propose better ways to help them help themselves. Opponents of ACA are the true champions of fairness, with our vision of non-coerced assistance for those who need it and of free individuals making their own choices instead of the government’s one-size-fits-all imperialism. Opponents of ACA are the ones who have compassion for the people this law hurts — not just those who in recent weeks have received cancellation notices, but the millions who will lose the insurance, doctors, choices, or price they liked, whether through mandated cancellations, breathtaking price increases, or ACA-induced job restructuring.
Legislatively, our slogan should be “Tell the truth, stop the bleeding, free Americans to find the cure.” We opposed Obamacare because we foresaw many of the problems that are now obvious and undeniable, and we need to attract bipartisan support to mitigate those problems now and set the stage for real health-care reform in the near future. Here are seven meaningful, achievable steps that will advance that goal.
1) End the congressional exemption. The top priority for anyone who is serious about minimizing the pending damage of the ACA is passing Senator David Vitter’s amendment. This would enforce Obamacare’s requirement that members of the House and Senate, and all their staffers, must buy their insurance on the exchanges, unsubsidized and without escape clauses — just as millions of Americans are now required to do. The Obama administration had provided subsidies to members of Congress and their staffs to soften the blow of large rate increases under Obamacare, and a further loophole option of declaring staff “not official,” which puts them back in the federal health program and out of the exchanges altogether; Vitter’s amendment would eliminate this special treatment.
The Vitter language is not only the embodiment of fairness and rule of law, but is important strategically: It provides the additional negotiating leverage of self-interest that will be needed to accomplish real delay. If Congress wants to keep its existing insurance for itself and its staffers, which it desperately does, achieving that would become conditional on extending the same opportunity to the rest of America.
The challenge is getting a vote. Undoing the exemption will be almost impossible for members to vote against, which is why Majority Leader Harry Reid blocked a clean vote on it in the Senate, and why too many Republicans — just as anxious as Democrats to preserve their benefits — refused to go along with GOP leadership’s efforts to bring it to a vote in the House as part of an attempted final offer during the shutdown.
(Be advised: Similar-sounding proposals that would undo the exemption for all federal employees are just a gambit — a show vote in which Republicans can vote yes, knowing that it will never pass, and Democrats have an excuse to vote no. Republicans get a campaign issue while still keeping their special treatment, at the price of forgoing the leverage in future negotiations that passage would have brought.)
The Vitter legislation is thus the litmus test for whether members genuinely want leverage that could help minimize the damage that the next three years of ACA will do. It is disturbing that leadership seems content with merely having held a vote on the issue during the continuing-resolution fight (as part of a package that failed in the Senate), giving them a good issue to use in campaigns but no change in the law.
If, in contrast, the House were to pass a clean bill, not only would it put enormous pressure on Senator Reid and his fellow Democrats to vote accordingly, but it would lower the threshold of votes needed in the Senate from 60 to a simple majority, which is actually doable. If we want serious triage on Obamacare, making it absolutely clear that a show vote on Vitter isn’t enough will be key.
2) Extend canceled insurance. Advocates of repeal must work to clear the federal obstacles that prevent individuals from keeping the insurance that they had, liked, and could afford, but have lost due to the burdens of Obamacare. This will require not only undoing the deliberately too-narrow “grandfathering” administrative language, but also undoing all the new insurance regulations that make these policies illegal. That’s a big job, and with millions of policies already canceled — never mind the further hurdles of state regulations etc. — it is unlikely that many can be reinstated; but perhaps at least a portion can, or additional cancellations can be prevented. It is important to be clear that this will be no panacea, but is only a first step to minimize damage that has been three years in the making. It will require bipartisan participation, and supporters should not overpromise.
3) Delay the individual mandate. It is important to propose (again) a delay in the individual mandate and the attendant tax penalty — which is paid by people who are not and likely never will be in the exchanges, for the benefit of insurance companies, because the government knows the exchanges are inherently unstable. Any such delay must be for a year, because moral fairness demands parity with the employer mandate — which has already been delayed a year by administrative fiat — and the logic of individual freedom tells most Americans (Justice Roberts notwithstanding) that such a mandate, call it tax or penalty, is anathema to our conception of limited government and individual rights. And that doesn’t even include the real data-theft risks that face those who sign up.
4) Require code transparency and data security. Who knew that the social-media masters who brought us Obama 2.0 in 2012 couldn’t build a website with rudimentary functionality and security? Transparency and data-security requirements for exchange websites are ripe for oversight and legislation. All the code for the Healthcare.gov website must be made public, as there is no proprietary interest here; open-sourcing would let Americans know what the coding actually directs once the website has a person’s data. That question has become particularly worrisome as we have repeatedly seen the gulf between what the law says and how bureaucrats have chosen to selectively reinterpret it. Errors and security flaws will be more quickly found with open sourcing as well.
We need, moreover, to make websites show the full price of insurance (which purchasers will pay if their income rises and they become ineligible for subsidies) and all the insurance companies from which they can choose — including full lists of the participating doctors and hospitals covered in their plan, so that consumers will know what they are — and are not — buying. Additionally, there should be basic data-security requirements and no obligation to divulge personal information before starting to shop for insurance.
Republicans need to demand that the standards that apply in the private sector to protect consumers against fraud, including bait-and-switch and determinations of liability, will apply to the government’s efforts as well.
Moreover, potential liability should be clearly laid out for the non-profits that are responsible for hiring and supervising navigators (at a cost of hundreds of millions of dollars to taxpayers, without even rudimentary criminal-background checks!), who have lately been documented encouraging false applications in order to procure unjustified subsidies for enrollees. They should be heavily punished wherever such fraud has been perpetrated, as well as being liable for any penalties the enrollee will then face. Multiple instances constituting a pattern of fraud and abuse should cause the automatic revocation of their non-profit status.
5) Ensure cost transparency. Republicans need legislation to make clear that if the promised additional cost-sharing (federal-government subsidies that flow to insurers providing additional subsidies to certain low-income consumers) gets cut by sequestration, then insurance companies, not taxpayers or low-income consumers, will have to make up the difference. This would be only fair to the low-income consumer, who is getting a sales pitch from assorted navigators to join these exchange products, while reminding insurance companies participating in the exchanges about their real potential costs.
6) Allow private competition. Republicans should advance legislation that allows companies not on exchanges to offer high-deductible, less comprehensive catastrophic-coverage policies to anyone, free of penalty, which would keep a private market in genuine insurance (as opposed to prepaid health care) ticking. You know, the stuff the administration decries as “junk,” but which many people find to be far better value for their money. It’s unlikely that this will pass, but it will be an important marker that Republicans value freedom and choice.
7) Propose alternatives. You can’t beat a horse without a horse. Republicans must start promoting the many credible true reforms that are alternatives to Obamacare, and make people know that there are far better ways to solve the real problems that exist in our health-care system. Without that, too many will be afraid to give up the devil they think they know.
Those who oppose Obamacare have their work cut out for them, but if they are serious, think strategically, and act together, there is much real good they can actually accomplish.
— Heather R. Higgins is president and CEO of Independent Women’s Voice, which runs the Repeal Coalition. The Repeal Coalition now has more than 200 participants, drawn both from a wide range of outside organizations and from inside the House and Senate.