Obamacare Going Forward: Conservatives Need to Understand the Challenge

| November 29 2013
John Walker

While Obamacare continues to collapse amidst delays in the law, cancellation of millions of individual insurance policies, and a wholly inadequate website, Democrats are reeling and Republicans are celebrating.

Nevertheless, it’s a truly human disaster that goes far beyond politics. Nothing is more personal than an individual’s or family’s health care. It is literally a matter of life and death.

So conservative members of Congress need to get busy, even as  they enjoy the Democrats’ pain. They have both an opportunity and responsibility to prepare policy alternatives. They need to ensure that their alternatives to Obamacare are sound.

Democrats will howl if they see popular alternatives to Obamacare. Barack Obama himself will lead the way. So the alternatives need to be as politically bulletproof as possible while still meeting the need to provide common sense health care.

Matt Lewis of the Daily Caller has come up with nine important things conservatives need to understand about moving forward from Obamacare. These are policy as well as political facts. They are well worth considering now before the focus moves from the failure of Obamacare to conservative alternatives.

1. Health Care has always been a Democratic issue because they had the great sob stories. But for the first time, we are beginning to see sob stories about people who’ve been screwed by government. If Republicans play their cards right, they have the potential to seize this issue in much the same way as — post-Iraq war — Democrats stole national security and foreign policy back from Republicans. Opportunities to change the natural political skew of an issue don’t come around very often, so it’s vital for Republicans to be ready.

2. The real problem for Obama might begin when people start showing up at their doctor’s office and are told they’re no longer in the “network” — or that they have no proof of insurance. People don’t tend to have a terribly close relationship with their insurance broker, but they do have a very intimate relationship with their doctor. Obama’s “If you like your doctor, you can keep your doctor” line might be the next huge disaster.

3. In order to capitalize, conservatives will have to be ready with a realistic alternative. Over the years, many ideas have been floated by people like Rep. Tom Price, Martin Feldstein, and (most recently) Ramesh Ponnuru and Yuval Levin. As opposed to mandates, these ideas typically involve tax credits, catastrophic coverage with high deductibles and low premiums, the ability to purchase across state lines, etc.

4. The big challenge any conservative alternative will face is: What do you do with pre-existing conditions? The only viable option seems to be to provide a one-time amnesty with very short enrollment periods (so people don’t think they can wait to sign up after they get sick.) This, of course. is messy and could pose a challenge for some conservatives.

5. It’s easy to poke holes in Obamacare, but the truth is that there probably is no perfectly free market alternative that would be politically viable. Pre-existing conditions are just one challenge. Here’s another: In order for the idea of tax credits to be salable (and workable as an incentive), they would have to be refundable. Some conservatives might not like this idea, but in order to incentivize coverage, people who don’t make enough money to have to pay taxes would essentially have to be transferred cash in lieu of a tax credit.

6. The irony of Obamacare is that it creates a marketplace and (for many people) divorces insurance from an employer-provided paradigm. If it crashes, the good news is that Obamacare will have trained many Americans — who previously thought their health care was on autopilot — to be more conscious managers of their own health care. Conservatives have always wanted a situation where individuals manage their own health care, and Obamacare might actually be a salutary (if ironic) stepping stone.

7. The most immediate problem for Obama is that nobody expects the website to work by November 30 (as was promised) and even if they clear that hurdle, the next deadline after that was just moved to December 23 – which is the date which you must sign up by, in order to receive health coverage by January 1. It’s predictable that a lot of people may experience a gap in coverage, which could cause Obama another headache in the New Year.

8. But that wasn’t the only deadline pushed back last week. Even more importantly, by pushing back the enrollment period until after the 2014 midterms Team Obama looks desperate. The impression is they are trying to hide the premium hikes until after the 2014 midterm elections. Is this a coincidence, or a transparent attempt to save Democratic Senators like Kay Hagen, Mary Landrieu, Mark Pryor, et al.?

9. This is not widely known, but the most anti-market provision in the law starts on January 1. If you buy coverage on your own or work at a small business, insurance companies will be taxed for the privilege of selling you that product. Aside from being a horrible precedent, it’s truly weird, inasmuch as it means we are taxing something that we’re subsidizing at the same time. Interestingly, big businesses self insure, so they won’t be on the hook for the new health insurance tax. Groups that represent small business have banded together to fight this tax.