While Republican lawmakers aren’t flinching in their quest to repeal Obamacare, conservative health wonks are more introspective in the wake of rising enrollment and evidence that the law — though it still faces many challenges — appears unlikely to collapse.
What should the party do if the Affordable Care Act survives?
For one, numerous conservative policy minds stress that Republicans need to coalesce around an alternative if they want the upper hand in the health care debate.
“As it becomes clear to opponents that the law is not going to implode on its own, they’ll have to come up with proposals to replace it when they have the power,” wrote National Review’s senior editor Ramesh Ponnuru in a column for Bloomberg View. “Replacement plans should make sure to include an amnesty for anyone who runs afoul of” the tax penalty for not buying insurance.
The right’s inward look includes a mix of anguish over their now-unlikely predictions that the law would unravel by itself, anger at President Barack Obama for unilaterally fixing some of its most disruptive components, caution that its problems aren’t yet over, and counsel for Republicans on what to do in a world in which Obamacare survives.
Another piece of advice comes from Michael Gerson, a former speechwriter for President George W. Bush, who says Republicans must recognize health care as a right for non-elderly Americans just as they do for seniors on Medicare.
“Conservatives need this to sink in: America already has a right to a certain minimum of health treatment, which is not going away. It is an expression of compassion and decency,” Gerson wrote in an op-ed for the Washington Post. “But the only way to credibly offer [conservative alternatives] is to recognize that access to some form of health care is a right in the United States — and was so, long before Obamacare.”
James Capretta, a respected health policy expert in conservative circles, wondered what sorts of executive actions a hypothetical Republican president in 2017 could take to damage Obamacare. He argued that Obama’s unilateral tweaks to the law have paved the way for a future GOP president “to use the same supposed executive authority to push the implementation of the law in a very different direction.”
Capretta said a GOP president could effectively waive the individual mandate penalty for everyone under a seemingly open-ended loophole carved out by the Obama administration. He also posited that a GOP president could further delay the employer mandate, reverse the birth control rule, neuter a market stability backstop known as risk corridors, undo cuts to Medicare Advantage and expand on Obama’s cancellations fix by letting non-compliant insurance plans return and “continue in existence on a permanent basis.”
James Pethokoukis, a policy writer for the American Enterprise Institute, argued that repeal is no longer viable even if Republicans come to power in 2017.
“Just a few years after one massive, convulsive change, Republican are going to offer another massive, convulsive change?” he wrote. Pointing to a set of changes to Obamacare floated by conservative health care consultant Avik Roy, Pethokoukis argued, “Whatever the flaws in the Roy plan, it has a big advantage in that it works off the status quo, rather than attempting to scrap the status quo.”