Before conservative policy wonks can win any policy victories, they'll need to overhaul the Republican Party. For an idea of what that might look like and the challenges any transformation will entail, they should look to one of the party's wonkiest politicians, Louisiana Republican Gov. Bobby Jindal.
Last week, as President Obama touted the 7.1 million private plan sign-ups in Obamacare's first open enrollment period, Jindal gave the world a glimpse at what the outlines of a Republican alternative might look like. Not only would the plan repeal Obamacare; it would, among other things, overhaul the tax code to remove the tax advantage for employer-sponsored health plans, offer incentives to states to protect access for individuals with preexisting health conditions, block grant Medicaid, expand health savings accounts, and create a $100 billion innovation fund for states experimenting with policies to bring down the cost of health care.
But just as important as the particulars was the simple fact that Jindal was offering something that many Obamacare proponents, including the president, had said did not exist: a conservative health care policy. At the same time, Jindal's plan was a challenge to his fellow Republicans to take health policy more seriously, to reckon with the tradeoffs it requires, and to begin the process of unifying around an alternative. It was a declaration, of sorts, that Republicans and the right could—and should—be wonky and policy focused too.
Jindal's proposal, released by his policy group, America Next, was not the first health policy plan to come from the right. In recent months, Rep Tom Price (R-Ga.), as well as GOP Sens. Tom Coburn (Okla.), Richard Burr (N.C.), and Orrin Hatch (Utah), have put forth ideas for overhauling the health system as well. But Jindal's proposal is a sign that the party is shifting its focus—not by giving up on repeal of Obamacare, but by thinking about what might come next. And because Jindal is a potential candidate for the party's 2016 presidential nomination, it is also a signal that that health care reforms will be a major issue in elections to come.
Republicans have often struggled with how to talk about health care, especially when their opponents promise expansive subsidized coverage benefits. Jindal's plan offers a hint as to how Republican candidates might sell their approach: Instead of emphasizing coverage, Jindal's plan prioritizes reducing the cost of health care. That's a potential weak point in Obamacare, which was sold as a way to reduce health insurance premiums for families, but will, as President Obama admitted last week, still result in premiums continuing to rise. (Obama's promise is now that premiums will rise slower than they would have in the absence of Obamacare.)
At 26 pages, Jindal's proposal suggests mechanisms, but still lacks a number of specifics. It would limit the tax deduction for many employer-sponsored health plans, but doesn't specify which ones, or how much revenue would be raised in the process.
That's not ideal, but also to some extent necessary. Those details are left out partially because of political considerations: The more specifics a plan has, the easier it is to attack. But it's also the case that it's easier to build upon—and agree to—a general framework than it is to simply adopt a proposal with every tiny detail already decided. This is the start of the exploration and negotiation phase for GOP health policy. Part of the purpose of Jindal's plan is to prod others into thinking about the details themselves.
That's not something that Republican politicians have done much of recently. During the last two presidential administrations, the GOP has let its well of domestic policy expertise run dry. Under Bush, foreign policy concerns took precedence; under Obama, mantaining opposition to the president's agenda became the focus. At this point, Republicans are more comfortable talking about what specific policies they stand against than those they stand for.
Jindal clearly wants to shift gears by pushing the party in a more solution-oriented direction. His health care plan is intended as the first in a salvo of big-picture policy proposals set for release. Those plans are meant both to prod the party in a new direction and to establish Jindal as the leader of its brain trust.
His challenge will be to convert his policy chops into political success. Jindal has plenty of wonky cred, but his role in the party sometimes feels more like that of a particularly prominent think tank scholar than a national political leader. He's a Rhodes Scholar with an Ivy League pedigree, holding degrees in both biology and public policy from Brown, as well as a political science degree from Oxford.
Yet Jindal's record as governor makes it clear that he is more than an Ivory Tower geek. He has a real record of accomplishments as governor—cutting Louisiana's income tax, expanding access to charter schools, pushing budget reform, and growing the state's economy at a faster rate than the nation as a whole in the years since before the recession. His larger vision, meanwhile, goes well beyond small-scale policy tweaks.
Conservative wonks hoping to overhaul the GOP, or Washington, will have a significantly tougher time than any governor. The existing policy barriers—the mass of federal programs and bureaucracies, all with constituencies in tow—are larger, and the political incentives for even sympathetic politicians to avoid difficult reforms are bigger still. Jindal's health plan is a strong nudge to a party that has long lacked policy direction, and a reminder that there's no better time to start the process of change than right now.