Replacing the rhetoric of ObamaCare repeal

Since the outset of the national healthcare reform debate in 2008, conservatives have recognized the need to infuse the health sector with better incentives and powerful market forces. Unfortunately, Rep. Nancy Pelosi (D-Calif.) and Sen. Harry Reid (D-Nev.) forced the government-centric Patient Protection and Affordable Care Act (ACA) onto the American people. Now, with Congress fully in Republican hands, the opportunity to create a better health care system presents itself. The key question is: does it matter how one gets there? 

Politically, the clear answer is yes. It goes almost without saying that both chambers will move quickly to vote on repealing the ACA. While the House has voted on measures seeking repeal in the past, the Senate has never voted on a full repeal of the law. Virtually every Republican member of Congress campaigned in support of repealing the law. Senators and representatives, particularly those newly elected, will understandably want to demonstrate their commitment to one of the preeminent issues motivating conservative politics today. Republican leaders simply must bring up a vote on repealing the ACA in the 114^th Congress. 

{mosads}Unfortunately, that vote will fail. No one believes that Republicans have the votes in the Senate to break a filibuster, and even if procedural maneuvers are used to get repeal legislation to the president’s desk, that legislation will ultimately be vetoed. There is no conceivable leverage Republicans could bring to bear on the president to achieve repeal. 

Yet for many activists and outside groups, sending bills repealing the ACA to the president and trying to find the pressure points needed to force his signature should be the preeminent focus of the next Congress. Unsurprisingly then, outrage erupted from these quarters when incoming Senate Majority Leader Mitch McConnell (R-Ky.) declared there will be no government shutdowns on his watch. There are apparently those who still hold to shutdown brinkmanship as a winning political and legislative strategy, despite ample evidence to the contrary. 

However, from a policy perspective it does not matter whether repeal comes first. What matters is getting the right reforms. Fighting the repeal battle again and again long after it has been lost does not further the cause; instead it removes you from the larger, ongoing fight. That fight—for a health care system built on free market principles of competition, personal responsibility and restrained federal power—can still be won. Republican leaders should issue a renewed call to arms as they open 114th Congress. We cannot repeal Obamacare–at least not without an exceptionally successful 2016 election cycle–but we can start the process of undoing the worst parts of the law, addressing the long-term budget implications, and building a better health care system. 

The desire for total victory is appealing but unrealistic in the next Congress; instead we should focus on what we can accomplish. There is bipartisan support for repealing the independent payment advisory board (IPAB). Consensus could develop around addressing the law’s detrimental impact on the labor market by increasing the definition of full-time work from 30 hours to 40 hours, or delaying—and hopefully repealing—the employer mandate. The Obama administration has already ensured that the individual mandate is little more than smoke and mirrors by offering so many exemptions that seemingly any individual can qualify for an exemption simply by getting out of bed in the morning. Why not take it the rest of the way and remove it altogether? The president himself has indicated he would sign legislation repealing the poorly designed and largely pointless medical device tax. Republicans could also seek changes to the health insurance exchanges, removing the age limit on more affordable catastrophic plans, allowing plan sponsors more flexibility in structuring their benefit packages, and strengthening the subsidy eligibility verification process. 

Compromise has become dirty word in Obama’s Washington, but compromise isn’t capitulation. Capitulation is the equivalent of running the ball toward your own end zone. Compromise is progress, it may not be the touchdown you hoped for, but you are advancing the ball in the right direction. We cannot repeal Obamacare in the 114th Congress, but we can make progress by moving the health care system toward real, free market based reforms if we seek attainable targets, and don’t waste scarce legislative time and resources on unachievable goals. 

Holt is the Health Care policy director at the American Action Forum, a conservative advocacy organization.