Republicans in the House voted for the 43rd time Friday to repeal or dismantle parts of the Affordable Care Act.
What exactly is the Republican endgame? Initially, it may have been about what House Speaker John Boehner, R-Ohio, calls the “optics”: allowing newly elected members to cast a symbolic vote on the law. Now they just look like spoilers.
Whether you’re a fan of Obamacare or think it’s the worst thing since socialized medicine (or that it is socialized medicine), you have to wonder what on earth the Republicans are up to. If Obamacare is so unworkable – if the inherent structure is so flawed as to increase demand for health care, reduce supply and send costs soaring – why not allow the law to be fully implemented and watch it implode? Wouldn’t that better serve their purposes, whatever they may be?
It is popular among conspiracy theorists to claim that Obamacare is a Trojan horse, a surreptitious way to introduce a single-payer system of universal health care. If you buy that argument, it follows that you have to kill it before it morphs into something else.
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If you aren’t partial to tinfoil hats, a better argument would be that time is running out. On Oct. 1, the state health-insurance exchanges will open for business. (The insurance purchased doesn’t take effect until Jan. 1.) Once the subsidies start flowing in January to low- and middle-income families, the law will be very hard to reverse.
The latest Republican gambit was an attempt to link a vote on a continuing resolution to fund the government after Sept. 30 to a rider that defunds Obamacare. There is no chance of such a measure winning Senate approval. If it did, President Obama would veto it. He’s already started to blame the Republicans for shutting down the government.
Republicans do have a plan, even though you may not have heard about it. Rep. Tom Price, R-Ga., has introduced H.R. 2300, the Empowering Patients First Act, just as he did in the 111th and 112th Congresses. Price, a physician, says the goal of his patient-centric proposal is to ensure access to health coverage for all Americans, control costs, solve the problems of portability and pre-existing conditions, and improve the health care delivery structure. Under Price’s plan, Americans would own their coverage, taking it with them when they change jobs. It would level the playing field by offering individuals a tax deduction, in addition to a refundable tax credit, for purchasing insurance. It would save billions of dollars by addressing lawsuit abuse, freeing doctors from practicing defensive medicine. And, yes, it would repeal Obamacare.
In addition, Republicans could emphasize the two biggest problems with today’s health care system: the fee-for-service cost structure, which encourages unnecessary procedures, and the system of employer-based coverage, a holdover from World War II.
When Republicans took control of the House in 2011, the largest caucus by far was the Republican Study Committee, a conservative group committed to ideological purity. Nothing there about governing. Members seemed to delight in being called the party of “no.”
With only a week to go before the insurance exchanges kick in and the federal government’s spending authority runs out, the study committee has finally unveiled its own alternative to Obamacare. It’s a bit late, but maybe the party of “no” is starting to focus on getting to “yes.”