Obamacare: Snatching a ‘Win’ from Repeal Defeat

Speaker Ryan’s approach to repealing and replacing ObamaCare is said to be “three-pronged.” This seems a muddled conception, because the second prong doesn’t involve Congress. Rather, it involves Secretary of Health and Human Services Dr. Tom Price, who can undo a host of Obamacare regulations all by himself. This second prong shows the weakness of the “administrative state”: regulations can be undone by the next administrator. So let the deregulations pour forth. You live by the administrative state; you die by the administrative state.

For Congress, there are just two prongs. The first prong is to repeal as much of the ObamaCare as possible through reconciliation, which isn’t subject to the filibuster and requires only 51 votes in the Senate. The Byrd Rule dictates that reconciliation can be used only for matters that involve the budget. Of course, the Senate might do away with the filibuster, but Republicans don’t want to do that right now. The second prong (formerly the third prong) would involve nonbudgetary items, like tort reform and buying insurance across state lines, items that would need 60 votes. Unfortunately, the Dems aren’t in a cooperative mood. And Ryan’s two-pronged approach has its other critics. In “Ryancare’s Fatal Logic Flaw” on March 13 at the Mises Institute, Hunter Lewis wrote:

What they ought to do instead is to craft a real Obamacare Repeal and Replace bill, fill it full of logical improvements such as allowing insurance companies to offer policies nationally, then stand back and let the Democrats vote it down and filibuster it. Having got the Democrats on record, they could then go back to bills based on Reconciliation, having put their best ideas forward. That would be easy for voters to understand.

Lewis seems to be urging that the two prongs be combined and drawn up into a bill that details the complete vision and solution of what Republican reform should be. Whilst driving on March 16, I heard El Rushbo float the same idea:

In this bill you load it up with everything you think it really should be. Don’t play games with first phase, second phase, third phase. Do a genuine repeal, come up with a genuine replacement, do it as though you had a free rein to do the best you could. Put everything in this bill that you, as a Republican and a conservative, want the health care system to become.

And in “The Real World of Obamacare Repeal” at NRO, also on March 16, Dr. Krauthammer also critiqued the multipronged approach:

Republicans could forget about meeting the arcane requirements of “reconciliation” legislation (which requires only 51 votes in the Senate) and send the Senate a replacement bill loaded up with everything conservative -- including tort reform and insurance competition across state lines. That would require 60 Senate votes. Let the Democrats filibuster it to death -- and take the blame when repeal-and-replace fails, Obamacare carries on and then collapses under its own weight.

These ideas have merit; perhaps it’s not too late to change strategy. But not all of ObamaCare will collapse. The part that will collapse is the so-called “Marketplace” for private health insurance; that is, the exchanges. The part that won’t collapse is Medicaid, which will keep chugging along on autopilot. If trillion-dollar federal deficits couldn’t kill Medicaid, a collapsing ObamaCare won’t either.

On Dec. 29 last year, I wrote that by using reconciliation Republicans wouldn’t be able to repeal the ObamaCare mandates. That appears to have been incorrect, as the second item on the House bill’s webpage is: “Eliminates the individual and employer mandate penalties.” One might conclude that since the Supreme Court redefined the individual mandate as a tax that it would now fall under the ambit of the Byrd Rule. Let’s hope that the Senate parliamentarian will advise that this is so and that the mandates can indeed be struck down through reconciliation.

In passing ObamaCare, Democrats were united, in lockstep. But Republicans are a diverse crowd, consisting of conservative diehards like the Freedom Caucus, moderates, and libertarians, (and perhaps the odd antidisestablishmentarian). Getting all these folks on the same page is like herding cats, if you’ll excuse the clichés. There’s the very real possibility that they may not be able to agree on a replacement for ObamaCare, and will come to an impasse. Such a nothing outcome would be a blow to their cause and their reelection prospects. However, there is one thing that most Republicans can agree on. So let me offer an alternative to nothing: pass a bill that does only one thing: repeals the mandates.

And there’s your “win,” Republicans, your ace-in-the-hole should all else fail. Surely all Republicans can agree that the mandates need to go. Such a simple bill would be a boon to business and President Trump could then fire the 16,000 IRS agents hired to enforce compliance with the mandates. I hear the president isn’t afraid to fire folks. And no one’s going to spend much time feeling sorry for a bunch of canned federal employees if it means the IRS gets downsized.

Jon N. Hall of Ultracon Opinion is a programmer/analyst from Kansas City.