War is over — if you want it.
The Republicans’ seven-year-long battle to simply repeal ObamaCare is dead. Pretending otherwise, like the Japanese holdouts who refused to surrender after World War II by hiding out in the Philippines, would imperil the opportunity the GOP still has to do serious health-care reform.
To do so, Republicans should stop thinking of ObamaCare as a separate entity and focus on what aspects of the health-care system most need fixing.
It would be the right thing to do for millions stuck with spiraling health costs. And it would be politically effective, showing the country that conservatives can still govern.
Take tort reform. In theory, legislation capping medical-malpractice awards should be bipartisan. In Texas, such reform “proved wildly successful,” according to City Journal’s Kathleen Hunker.
One obstacle would be the powerful hold trial-lawyer lobbyists have over Democratic politicians. Another would be Democrats’ temptation to refuse to work with Republicans on health care — at all.
“Senate Minority Leader Chuck Schumer of New York has said his party is willing to discuss improvements to the law, but only if Republicans drop their seven-year-long dream of repealing it,” writes Bloomberg political reporter Steven T. Dennis.
So call Schumer’s bluff. And here, Republicans have more leverage than they might think.
There is no way for President Trump to undo all of ObamaCare through executive orders or regulatory adjustments. But that doesn’t matter now, because he can still change a lot. And he should use that power to lure Democrats to the table on bipartisan legislation.
This was, in fact, part of the original plan. A few days after Trump’s victory in November, Reuters reporter Susan Cornwell talked to GOP Sen. John Barrasso, a member of the party’s leadership, about health care. Barrasso said the key would be to get an HHS secretary confirmed ASAP. Why? Repealing ObamaCare in full, he said, “is not a ‘Day One’ activity. But a new secretary of HHS going after the regulations can be a ‘Day One’ activity.”
Time to go back to Square — er, Day — One.
At the blog The Incidental Economist, health-policy expert Adrianna McIntyre and law prof Nicholas Bagley put together a list of executive actions Trump could take to change aspects of the Affordable Care Act himself — with no need for Congress to go along. A sampling:
- “Narrow the essential health benefits rule.”
- “Allow [Medicaid] work requirements, premiums and more cost-sharing under” Section 1115 of the Social Security Act.
- “Permit more states to use Medicaid dollars to subsidize private exchange coverage.”
- “Expand the reach of the contraceptive mandate accommodation (currently available to religious nonprofits and closely-held for-profit companies).”
- “Delay enforcement of the employer mandate.”
And there are others. Trump, for example, seems to like the idea of allowing for the sale of insurance policies across state lines. That may or may not be worth the trouble: The American Enterprise Institute’s Joseph Antos wrote last year that ObamaCare has expanded “essential health benefits” to the point where — without changing Uncle Sam’s interpretation of those benefits — there is less variation state to state anyway.
And that gets to the larger point here. Republicans rightly fought ObamaCare’s passage with the understanding that once a monumental reform of one-sixth of the country’s economy was implemented, it would be hard to undo. Indeed, in 2013 Sen. Mitch McConnell demonstrated this by claiming, justifiably, that there had been 20,000 pages of regulations “associated” with ObamaCare.
That is, the legislation itself was just the start.
The lesson, then, is that full repeal is likely a fool’s game at this stage — but that the federal bureaucracy now under Trump’s direction has wide latitude to interpret many areas of the law.
Trump and Price can and should take advantage. It would fulfill Trump’s populist message while putting Democrats on the defensive — and giving them reason to come out and negotiate broader changes.
When the most famous Japanese holdout, Hiroo Onoda, finally surrendered nearly 30 years after WWII ended, his uniform, cap and sword were “all still in good condition,” according to The Associated Press. Republicans can keep their uniforms clean and marinate in the denial that ObamaCare writ large is here to stay, or they can roll up their sleeves and get to work.