How to fix the Oba­macare fi­asco Repub­li­cans must fo­cus on choice, com­pe­ti­tion and cost re­duc­tion

The Washington Times Weekly - - Commentary - By Stephen Moore

It’s no grand rev­e­la­tion that Repub­li­cans have bun­gled the Oba­macare re­peal bill be­yond be­lief. Sen. Mitch McCon­nell wants a Sen­ate vote on full re­peal of Oba­macare with two years to come up with a re­place­ment. This would be the ideal so­lu­tion, but it ap­pears he lacks the nec­es­sary 50 votes for pas­sage. In that event, there is still a path to vic­tory through a smart change in tac­tics and mes­sag­ing.

What is killing the Repub­li­can re­form ef­fort is the fatu­ous Con­gres­sional Bud­get Of­fice pro­jec­tions that some 20 mil­lion peo­ple will lose their health in­sur­ance un­der vir­tu­ally any Repub­li­can plan. Vot­ers don’t sup­port that out­come.

To win this fight the GOP must change the nar­ra­tive and fo­cus on the “Three Cs of Health Care Re­form”: choice, com­pe­ti­tion and cost re­duc­tion. These will lower pre­mi­ums to make health in­sur­ance more af­ford­able for tens of mil­lions of Amer­i­cans. They are also pop­u­lar prin­ci­ples with vot­ers. Oba­macare promised all of these things and de­liv­ered the op­po­site: less choice and com­pe­ti­tion and much higher costs to fam­i­lies.

To fo­cus the de­bate on “the Three Cs,” Mr. Trump and Repub­li­cans may have to make a guar­an­tee that Amer­i­cans won’t be thrown off Med­i­caid and that no one will lose in­sur­ance. Repub­li­cans have run into a buzz saw on that is­sue and his­tory is re­peat­ing it­self here.

For more than three decades now Repub­li­cans have nobly tried to “rein in” so­cial pro­grams only to have their heads handed to them time and again.

In 1981-82 Ron­ald Rea­gan pro­posed cap­ping the cost of liv­ing ad­just­ments for So­cial Se­cu­rity re­cip­i­ents. It was a po­lit­i­cal de­ba­cle for the GOP that blew up in Mr. Rea­gan’s face.

In 1995 a new House Repub­li­can ma­jor­ity tried to cut Medi­care costs. Democrats ran their fa­mous “Medis­care” cam­paign against Repub­li­cans, with TV ads show­ing grandma be­ing pushed off the cliff in her wheel­chair. Repub­li­cans were like lambs at the slaugh­ter.

It’s hap­pen­ing again with the Repub­li­can Med­i­caid re­forms — so that fight will have to wait for an­other day when and if Democrats are ready for a grown-up con­ver­sa­tion about en­ti­tle­ments.

For now the cen­ter­piece of the Repub­li­can plan should be to give every le­gal Amer­i­can res­i­dent an “off ramp” from Oba­macare so they can choose their own af­ford­able plans. This means end­ing the in­sur­ance re­quire­ments, in­clud­ing Oba­macare’s un­pop­u­lar in­di­vid­ual man­date (which mostly pe­nal­izes fam­i­lies with in­comes be­low $50,000 a year).

This ap­proach to health care re­form (sim­i­lar to the Ted Cruz amend­ment) means tens of mil­lions of fam­i­lies would be lib­er­ated from Oba­macare overnight and could opt for high de­ductible HSAs or sim­ple cat­a­strophic cov­er­age to pro­tect against ma­jor med­i­cal ex­penses for them­selves or their fam­ily.

To fur­ther lower costs, Repub­li­cans must al­low fam­i­lies to buy in­sur­ance across state lines, elim­i­nate the em­ployer man­dates that has de­stroyed jobs, and ex­pand trans­parency in pric­ing with re­quire­ments that hos­pi­tals and doc­tors post prices for ser­vices like an MRI or a colonoscopy so pa­tients can shop around for low prices.

Democrats would have to de­fend their an­tifree­dom po­si­tion, which is that Amer­i­cans should not be per­mit­ted to choose their own in­sur­ance plan and pay less. They can’t.

Lib­er­als and their health in­sur­ance in­dus­try al­lies will ar­gue that the in­sur­ance mar­ket can’t work if healthy or younger peo­ple can choose cheaper plans and they warn of an in­sur­ance death spi­ral. But the death spi­ral they warn of — with healthy peo­ple drop­ping out of Oba­macare and sick peo­ple sign­ing up — is

For now the cen­ter­piece of the Repub­li­can plan should be to give every le­gal Amer­i­can res­i­dent an “off ramp” from Oba­macare so they can choose their own af­ford­able plans.

al­ready hap­pen­ing day af­ter day un­der the cur­rent law — and ev­ery­one knows that.

Un­der a choice­based sys­tem per­haps as many as 80 per­cent of Amer­i­cans will see pre­mi­ums fall by as much as $3,000 to $5,000 a year. As costs come down, more will sign up for cov­er­age and if the CBO doesn’t get this sim­ple rule of eco­nom­ics, they should be fired. Lib­er­als un­der­stand that giv­ing Amer­i­cans the right to freely choose their own in­sur­ance plan will quickly ren­der Oba­macare and its ex­pen­sive man­dates and reg­u­la­tions ir­rel­e­vant. It will be the death of Oba­macare.

Isn’t that what Repub­li­cans want? Stephen Moore is a co-founder of the Com­mit­tee to Un­leash Pros­per­ity and is a se­nior eco­nomic an­a­lyst at CNN.


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