Next Up With Obamacare – Obama’s Call to “Mend it, but Don’t End it”
The end of the year is a good time to begin anticipating the opportunities that lie in future. So let me go out on a limb about a likely development for 2014.
Sometime after the New Year, President Obama will call on Congress and Republicans to make “technical corrections” to the Affordable Care Act. He will make no acknowledgement of the many Obamacare problems. Instead, he will continue to hail his bill as a success, but simply in need of a few bipartisan modifications. If pressed to put an exact date on when this will happen, it will be on January 28th when the President gives his State of the Union address.
This strategy offers Obama a number of advantages. It provides political cover to Democratic Senate incumbents in trouble in the 2014 elections. They will say: “Sure there are problems with Obamacare, and we are working to fix them.” Also, bipartisan appeals represent a classic tactical response for a President facing bad polling.
Obama’s “mend it, but don’t end it” approach also lets Democrats at least try to shift responsibility toward Republicans. They will say: “Sure there are problems with Obamacare, but the Republicans would not compromise on our fixes.”
This “mend it, but don’t end it” strategy also has the political appeal to Democrats in dividing Republicans and conservatives between those who want to hold out for complete repeal, and those prepared to address the real pain their constituents are enduring now. If the Democrats are lucky, they will succeed in reigniting the simmering divide among Republicans into a civil war over political tactics. Those that equate all compromise with surrender will oppose any negotiations.
However a “mend it, but don’t end it” strategy objectively presents Republicans with a splendid opportunity to begin to remake health care policy away from government control and toward free-market and patient centric principles. While we should acknowledge that full repeal is all but impossible until 2017, in the interim significant positive changes can be made:
- Ending Mandatory Health Policy Provisions- The primary cause of the lie, “if you like your plan, you can keep it,” has been that Obamacare dictates what an “acceptable health care plan” must contain. In a free market, Americans can choose products that meet their needs and insurers are allowed to design plans to compete for that business.
- Allowing for Health Insurance Competition Across State Lines – Allowing consumers to buy plans across state lines gives consumers more choices and prevents states, like Maryland, from piling own their “acceptable coverage” requirements. States with fewer mandates have more alternatives among carriers and are more affordable.
- Allowing Employees More Choice for their Health Coverage – Many employers are now burdened with having to select plans their employees choose among. Instead, employees should be freed to use their employer provided health benefits dollars to subsidize (or pay for entirely) a health care plan chosen from a broader array of alternatives. (And the exchange need not be government operated. We know how well that works.)
- Equalizing the tax advantages employers and individuals have – Employer paid health care plans enjoy substantial tax benefits over plans paid for by individuals. Equalizing this tax treatment will end the disadvantage that individuals and the self-employed currently face.
- Freeing States to design their own Medicaid plans- Converting Federal Medicaid support to block grants and freeing states to devise health coverage for the poor and uninsured will incent states to hold down spending with their individual approaches.
To be sure, we are very unlikely to accomplish all of this until 2017 at the earliest. For example, changing anticipated Federal-State Medicaid funding for Obamacare expansion may be the hardest reform to accomplish in the near term. However already half the states have opted not to accept Medicaid expansion for Obamacare. It is utterly unsustainable to expect one half of the country to pay the other half’s Obamacare Medicaid expansion. Instead, each state should receive block grants and flexibility to design their own individual state Medicaid programs.
Completely ending both the individual and employer mandate may be a harder achieve in the short term as long as Republicans and conservatives lack either the Presidency or two-thirds of Congress, although further delays are possible. Mandates remain at the very core of the Obamacare scheme.
In the coming year, when Republicans and conservatives hear “mend it, but don’t end it,” we need to respond to it though a green light to push for free-market healthcare reforms. By focusing on creating a more robust marketplace along patient centric principles, Republicans can make real progress at moving healthcare away from the top down government centric approach taken by Obamacare.