Senators, you passed ObamaCare repeal-only bill in 2015 — do it again

After struggling to pass a bill that would repeal and replace the Affordable Care Act (or ObamaCare), Senate Majority Leader Mitch McConnell is going with a different approach.

It’s a new strategy, but it’s modeled after an older plan, a budget-reconciliation bill passed by both houses of Congress in 2015. The measure repealed most of ObamaCare, but was quickly vetoed by then-President Obama.

Ultimately, this strategy could result in a better final product — a better healthcare law that will benefit all Americans. Along the way, this bill will face some challenges, but it will also offer some opportunities for better policymaking.  

First Republicans have to get this new bill, called the ObamaCare Repeal Reconciliation Act, to the floor for a vote. If it gets there, it can be amended.

Like the version that passed in 2015, the current bill includes repeal of ObamaCare’s taxes, and mandates, and phases out the subsidies and Medicaid expansion over the course of the next two years.  However, also like the 2015 bill, the current repeal bill won’t change ObamaCare’s regulations on private insurance.  Purportedly, that’s so that it can be considered under rules known as “budget reconciliation,” which allow a bill to pass with only a simple majority of votes, instead of needing 60.   

{mosads}The limits of what the Senate can do under budget reconciliation have been a stumbling block for Republicans during their health reform effort. It’s not clear to what extent insurance regulations can be altered via this process. But Republicans have clearly grown bolder: The repeal-and-replace bill that passed the House in April of this year, as well as the latest repeal-and-replace bill under consideration in the Senate, would have included regulatory changes.

Specifically, the House allowed states to obtain waivers from two major rules in ObamaCare: the “essential health benefits” or the federal requirements on what all insurance plans must cover, and the “community rating” rule, which limited insurers’ ability to price insurance premiums according to health status or risk.

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The Senate was considering — but did not pass — a proposal from Sen. Ted Cruz (R-Texas) that would have allowed insurance companies to offer plans that did not meet all of ObamaCare’s requirements, so long as they offered at least one compliant plan.

These changes are commonsense policy: They would allow Americans to buy insurance plans that fit their own needs and preferences, as well as their budgets. They would increase competition and choice in insurance markets and ultimately lower premiums, which have more than doubled on average under ObamaCare.

The recent legislative history indicates that Republicans are more and more willing to experiment with at least some regulatory changes, even using the budget reconciliation process. Ultimately, it would be the Senate parliamentarian’s decision whether any provisions were not allowable under Senate rules, but Republicans should push the limit of what they can do and amend this latest ObamaCare Repeal Reconciliation Act to also include as much repeal of the law’s regulations as possible.

In the short run, this strategy will shift the pressure from conservative Republicans — who’ve been reluctant to support GOP replacements for the ACA — to moderate Republicans, many of whom say they oppose ObamaCare but hesitate to repeal it.

In the long run, this strategy has two possible outcomes: The bill may fail, which would at least make it clear to voters which Republicans have reneged on the promise of ObamaCare repeal. Or it might succeed, setting in motion the needed momentum for a better health reform policy.

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Republicans — and Democrats — recognize that the world before ObamaCare wasn’t perfect, and a repeal-only bill isn’t enough to solve all of our healthcare problems.   

But hitting the reset button on health reform would create an opportunity for members of both parties to truly tackle the core problems that plague American health care: To address ever-escalating costs, to break the distortive link between employment and health insurance, and to reform and strengthen our safety net, including Medicaid and guaranteed protection programs for people with pre-existing conditions, or high-risk pools.

These are important health policy debates to be had; repealing ObamaCare in full can be the first step. As the Senate pivots to a new strategy, lawmakers should have the support of all Americans who care about achieving a better healthcare policy.

Hadley Heath Manning is the director of health policy for the Independent Women’s Forum. Her work has been featured in The Wall Street Journal, Forbes, POLITICO, Roll Call, Real Clear Policy, National Review Online, and Huffington Post, among others. Manning is also the Tony Blankley Fellow at the Steamboat Institute. Follow her on Twitter @HadleyHeath.

The views expressed by contributors are their own and are not the views of The Hill.