Conservatives may be largely united in their opposition to Obamacare, but they will not be able to repeal it until they can reach a consensus on how to replace it, experts say.
Author Philip Klein, in his new book “Overcoming Obamacare,” identifies three primary strains of conservative thought with regard to repealing Obamacare—the “reform” school, the “replace” school and the “restart” school.
At an event hosted by the Cato Institute on Tuesday, policy experts representing all three schools came together to discuss the differences between the various approaches and to present their visions of how best to create a truly free market in health care.
Avik Roy, a senior fellow at the Manhattan Institute, spoke on behalf of the reform school, arguing that simply repealing Obamacare would be a hollow victory, because “Obamacare is not the only thing we have to overcome.”
Despite its $1.3 trillion cost, he pointed out, “Obamacare is a small fraction of total health care spending,” so any effort to roll back government involvement in health care must also address Medicare and Medicaid. (RELATED: Doctors Begin to Refuse Obamacare Patients)
Jeff Anderson, the executive director of the 2017 Project, which advocates replacing Obamacare with conservative solutions, forcefully asserted that, “Health care is not a right; it is a good.” Yet he also acknowledged that, “the surest way to NOT repeal Obamacare would be to disrupt health coverage for millions of people,” suggesting conservatives must articulate a politically attractive alternative in order to achieve the goal of repeal.
The problem with the reform school’s approach, he said, is that it assumes “repeal is not important,” and that a few minor tweaks would be sufficient to render Obamacare pro-market, both of which notions he rejected.
Roy countered that although his plan does not necessarily require full repeal, it does repeal “big chunks” of Obamacare, and creates a framework for transitioning to a more market-oriented approach.
“If some kernels of Obamacare can help us reform Medicare and Medicaid,” he argued. “Then we have an obligation to use them.” (RELATED: Gruber in 2009: Obamacare Will NOT be Affordable)
Perhaps the most radical outlook aired at the meeting came from Cato’s own Michael Cannon, who argued that not only should Obamacare be repealed, but so should other government health care programs, which he claimed would unleash the innovative power of the market.
One of the most lauded aspects of Obamacare, Cannon noted, is its prohibition on denying coverage to individuals with pre-existing conditions. Yet few people realize that before the debate over health care reform even began, “the market was innovating right under Congress’ nose,” allowing individuals to purchase protection plans to prevent their premiums from rising in the event they developed a chronic condition.
Obamacare regulations also block other insurance innovations, Cannon said, such as “total satisfaction guarantees,” which he speculated most Americans would love to have.
Cannon said he is “concerned about whether innovation-killing provisions would survive” under more-moderate schemes for repeal, saying those plans “are Obamacare-Lite because they retain refundable tax credits, which are redistribution of income.” (RELATED: Report: Premiums Rising Faster Under Obamacare Than Eight Years Before COMBINED)
In response, Roy conceded that, “a libertarian insurance market would be better than the one we have now, but doesn’t have the political support,” adding that the main consideration among the competing approaches comes down to “what we think is politically feasible.”
Given that universal health care remains a popular concept, even if specific embodiments have proven less so, Roy argued that conservatives should focus on finding ways “to get government out of the market,” rather than fixating on the elimination of subsidized health insurance.
By replacing subsidies with tax credits, he explained, “we can actually cover more people than Obamacare while spending less money, and there are people on the center-left who are open to that.”
“If all you look at is a narrow range of options that seem politically feasible,” Cannon replied. “Then that’s all you get. Our goal is to expand the window of feasible policy options.”
“If you can paint a vision of a completely free, fully reformed health care system,” he asserted. “People will listen.”