Why Republicans have such a hard time passing health care legislation
A clash between public opinion and political narratives
There have been an intense number of attempts by Congressional Republicans to repeal the Affordable Care Act (ACA)—otherwise known as Obamacare—so far this year, including Sen. Rand Paul’s Obamacare Replacement Act, House Speaker Paul Ryan’s American Health Care Act, the July “skinny repeal” bill, and most recently, the Graham-Cassidy bill, all of which are either likely to fail or have already failed. At this point, Republican health care bills are essentially cock-and-bull, indefensible manifestos against Obama and the Democratic Party slathered with a couple Friedman-esque features. Comedians, news commentators, the vast medical organizations across America, politicians and citizens from all parties have lashed out against these fiscally conservative, state-oriented pieces of legislation as they get annihilated in the Senate.
The constant threat of losing health care has loomed over America ever since Inauguration Day in January. President Donald Trump had vehemently talked about repealing and replacing the ACA throughout the 2016 presidential campaign. Fear was even greater once the election was over and the blue majority in Congress that liberals had hoped for did not come. In March, shortly after Paul Ryan unveiled his initial health care plan, I wrote an article wondering why Republicans hated Obamacare in the first place. The answer, unsurprisingly, could be traced back to the ACA’s mandates, excise taxes, and federal maintenance of the health care market.
In this column, I’d like to make a claim that may seem intuitive but strangely bold: in our current political, economic, and social climate, there is no such bill, real or unreal, that aims to roll back federal government spending and guarantee health care to more Americans at the same time. There are scores of alternative health care systems that the United States can trial-and-error, but the rigid nature of the American government appears to be a very difficult obstacle to overcome. When the idea of single-payer health care fails to gain traction despite all its benefits, it’s clear that Americans—and the American government—just don’t vibe widdit. Within the current realm of possibility, it’s evident that fiscal conservatism is no catalyst for getting people on board the Republican health care train. But why?
The most recent Republican health care legislation was the Cassidy-Graham Bill, which largely intended to gradually roll back federal subsidies in favor of issuing block grants to the individual states, leaving at least a large portion of the task of dictating health care policy to state governments. There are two reasons why this is a terrible idea. First, states like to do things completely different from one another, leading to an incoherence that could lengthen wait times and make health care less accessible depending on which state you’re in. California, a state whose legislature leans left, could very potentially pass single-payer health care, while Alabama, a state whose legislature leans right, could leave options up to private companies. Second, states can use the new discretion granted to them through block grants to deny subsidy recipients coverage of various services, such as pre-existing conditions and abortions.
But what is most influential in the destruction of Republican health care ventures is a matter of public opinion and political narratives—perhaps even a clash between the two. I watch so many conservatives like Sen. Bill Cassidy on CNN, Rand Paul on Fox News, Sen. Mitch McConnell, R-Ky., in Congress, and Paul Ryan in front of his stupid, stupid PowerPoint all struggle to defend their legislation, because deep down, we all know that you cannot scale back funding and expect more people to be covered without completely restructuring our health care system—which, because of political resistance, is highly unlikely. Fiscal conservatism works against the government’s efforts to expand coverage to more people—they’re contradictory. Reducing federal funding and moving power and cash over to the states is ineffective. And that’s why Republican health care bills never seem to best the ACA in the eyes of voters.
The market’s price for health insurance as defined by all the corporations involved in a multi-payer health care system is too high for millions of Americans and American families, so the government must subsidize a vast portion of these costs—state and federal. Because states have different ways of conducting business, the wellbeing of individuals across the country can vary, which is inherently unequal. The ACA dumps a lot of cash into the expensive health care costs of the sick while taxing the bejeezus out of the healthy and the rich through expanded excise taxes, not to mention enforcing a mandate for healthy people to buy insurance to keep prices affordable. But now that Republicans want to get rid of all these ceilings or floors or taxes for a product that is relatively inelastic, there shouldn’t be any level of surprise when the CBO, Moody’s, S&P, or any other ratings agency says that millions of Americans will lose coverage.
There are alternatives to this “we like Obamacare but don’t like that it has ‘Obama’ in it” type of legislation.
In July, Ed Dolan, a senior fellow at the Niskanen Center, wrote an op-ed in Vox proposing “universal catastrophic insurance,” a more free-market-oriented method of health care that, in layman’s terms, utilizes certain caps and requirements to cover more people, albeit less comprehensively, at a lower cost. However, judging by its disparity from America’s current system, its implementation would require a massive overhaul of our current one, which likely isn’t going to happen anytime soon due to politics. Not to mention, Republicans are unlikely to touch universal catastrophic insurance because of its disproportionate burden on small businesses and lower-income workers.
America’s health care system is obviously inefficient; Americans pay more for health care per capita than any other country on the planet without any noticeably better care. This means that there is room for improvement and a possibility for more people to have quality health insurance in the near future. However, health care policy must first jump the hurdle of politics, and the Republicans can’t seem to do it, which means it’s time to start having public hearings, talks with Democrats, town halls with constituents, counsel from economists and health care experts, discussions with media and panels, but most importantly, an open mind and an open heart.
Macroeconomics Professor Winthrop Hambley contributed to this column.
Mark Lu is a freshman in the School of Public Affairs and a staff columnist for the Eagle.