In 2009, when President Obama proposed his healthcare bill, Republicans warned it was the first step toward a single payer system. Eight years later, if Washington Republicans do not change course soon, they will make that prediction reality.
Washington Republicans are operating under the faulty assumptions that they must pass a healthcare bill quickly to “move on” with the rest of their agenda and that the collapsing individual health insurance marketplace is giving them the momentum and mandate they need to do so. Two recent events should cause them to reconsider.
{mosads}First, look at the election in Great Britain. Six weeks ago, Theresa May’s conservative party was leading most polls by 20 points. Then May’s Tories made the mistake of proposing changes in the way British citizens were taxed in home care, which is primarily used by the elderly. These measures might have made macroeconomic sense to the Tory policy experts, but the Labour party successfully branded the change a “dementia tax.” Health care is an intensely personal topic, and voters care more about how laws personally affect them than they do about the system at large. The Tories backed off, but the damage was done, and British voters made them pay at the polls.
In Washington, Republicans are making similar errors with their healthcare proposals. At the macroeconomic level, the American Health Care Act is far more stable and functional than ObamaCare. However, several micro-level problems make the bill politically toxic. For example, the bill’s tax credit structure, when combined with an otherwise sensible change in regulations governing the difference in premiums allowed for young and old customers, opens the bill to being branded an “age tax.” Republicans need only to look overseas to see how the public would respond to an “age tax” branding.
The lesson to learn from the British election is that Republicans are better off slowing down. They should think through all the practical, individual impacts their health care bill will have as it goes through the Senate and conference processes. Otherwise, they are likely to fail to pass healthcare reform — or worse, they might pass a bill that is unacceptable to the American people. Either result would bring huge Republican losses in 2018 and further entrench ObamaCare.
The second relevant recent event received much less attention, but it could also be a harbinger.
Like many states, Nevada has been trying to deal with its collapsing individual marketplace. To provide Nevadans more affordable choices, the state’s legislature passed a bill that would allow anyone to enroll in the state’s Medicaid program – essentially creating a public option.
On Friday, the bill was vetoed by the state’s Republican governor, who rather than saying he opposed the idea, said it needed further study.
A public option should be anathema to any Republican, but the failing marketplace has put Governor Brian Sandoval in a difficult position. Ten of 17 counties in Nevada only have one insurer option for silver level plans. The other seven have no more than three. They need a solution.
The situation in Nevada shows that chaos and instability in healthcare does not help the Republican case for free market reform — it undermines it. Increased voter anxiety and financial stress caused by the collapse of ObamaCare will increase pressure on lawmakers to accept rash, big government decisions over sustainable ones. It will erode trust in more responsible Republican health proposals. Voters will associate the party in charge with their current pain and will question whether the private market can offer affordable coverage.
Republicans must solve the immediate crisis in the individual markets and take time to write a responsible health care bill. Both are possible.
Taking simple steps to stabilize the individual marketplace will give Republicans breathing room to develop a health care bill the American people will like. But they need to act fast. The window to stabilize the marketplace for 2018 is closing.
In most states, insurers must submit their 2018 rates by June 21, 2017. Without commitments to stabilize the marketplace, insurers will submit rates based on worst-case scenarios, or continue to pull out altogether.
Republicans should start by following Senate Health Committee Chairman Lamar Alexander’s recommendation to fund the Cost Sharing Reduction program through at least 2018. They should also consider making available funding for states to defray the costs of those with significant medical conditions.
Both of these actions are part of the American Health Care Act. Taking these actions now will provide some stability for state governments to avoid rash decisions while Republicans in Washington work on a fuller health reform package.
This measured, slower approach to repealing and replacing Obamacare may not have been the ideal scenario Republicans imagined in their high spirits after winning the election in November. But given current circumstances, it is the responsible choice of a governing party dedicated to solving problems in the most practical way.
Republicans won a mandate to govern, now they must do so.
Newt Gingrich is a former Speaker of the House of Representatives.
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