Republicans may offer a unified, leadership-backed replacement for the Affordable Care Act. But the party is still split on both the politics and policy of health care reform, with some conservatives urging the GOP to simply continue chipping away at the President Obama’s health care law.
Congressional Republicans haven’t offered any truly serious legislative solution to the health care crisis since the health care reform debates of the 1990s. Then, the party felt compelled to produce a counter-proposal to President Clinton’s “Health Security Act” and ended up endorsing a plan that relied heavily on individual responsibility and the individual mandate. The GOP quickly abandoned the idea once President Obama officially embraced the mechanism in 2009 and has since largely stayed away from offering too many legislative specifics for extending universal health care coverage and lowering health care costs.
Several Republicans have produced independent health care bills before and after the ACA became law, but the party has yet to rally around any single proposal. Here are four reasons why they never will:
1. Republicans have promised, and failed, to produce an alternative in the past. The GOP has formed numerous “working groups” dedicated to developing a health care proposal, but they’ve never resulted in comprehensive legislation. And from press reports, Congressional leaders are still divided. Earlier this year, House Majority Leader Eric Cantor (R-VA) told House Republicans, “This year, we will rally around an alternative to Obamacare and pass it on the floor of the House.” House Budget Chairman Paul Ryan (R-WI) appeared to disagree. During an appearance on Bill Bennett’s Morning in America last week, Ryan suggested that the party would not offer a single measure. “There are good conservatives who just have various different ways of putting an alternative out there,” he said. “[W]hat you’ll see the House doing is passing individual reforms — you know one a week — on these common themes.”
2. A GOP alternative would be a poor comparison to the health reform law. Republicans are unlikely to endorse any proposal that would guarantee universal coverage and would thus fare poorly in comparison to current law. For instance, while the ACA extends insurance to some 30 million people, a 2009 GOP proposal would have only covered 3 million people. Though they endorsed universal coverage in the 1990s, Republicans now believe in “universal access” — the idea that everyone should have access to, but not necessarily purchase, health care coverage.
Under their proposals, young and healthy applicants will be able to find insurance on the individual market (some, even across state lines), but sicker and older beneficiaries would have to turn to state-based high risk insurance pools. The ACA tried and failed to effectively implement a similar program and multiple analyses have found that covering all high-risk Americans through these pools is likely to be prohibitively expensive. According to a 2008 report from the Tax Policy Center, using high-risk pools “to prevent large losses in insurance coverage among the sick and needy could be extremely expensive—on the order of $1 trillion over ten years given projected health care costs.” Under the GOP’s alternative, millions would lose Obamacare coverage and would likely remain uninsured.
3. Republicans would end up having to embrace some parts of Obamacare. The GOP’s potential replacement legislation is similar to the health care plans offered by Sens. John McCain (R-AZ) and Mitt Romney in 2012 and their latest replacement is unlikely to break any new ground. If anything, these measures borrow heavily from provisions already included in the ACA — allowing children to stay on their parents’ health care plans, mandating insurers to renew policies — and would require the party to tacitly accept parts of a law that many still see as unconstitutional.
4. The politics of an alternative are tricky for the GOP. Some Republican strategists have long argued that the party doesn’t need a positive governing agenda to take back the Senate and hold on to the House. Dissatisfaction with President Obama and his policies is so high that running against Obama and his policies should be enough, they say. Others contend that it will be difficult to build party consensus behind any single proposal and tell Politico that any measure that retains certain parts of the law and repeals others could provide Democrats in vulnerable districts the opportunity to vote for an alternative to Obamacare.