Obamacare

The GOP's Obamacare Repeal Bill Has Finally United the Right On Health Care—Against the Bill

Conservative and libertarian activists and policy wonks have all expressed opposition to the House repeal plan.

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Bastiaan Slabbers/NurPhoto/Sipa/Newscom

At a health care conference in Florida earlier this month, John Boehner, the former Republican Speaker of the House, said he "started laughing" when he first heard about the GOP's plan to rapidly repeal and replace Obamacare.

"In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a health care proposal should look like. Not once," Boehner said, in remarks first reported by Politico.

Boehner was, if anything, understating the party's internal disagreements. Not only did Republicans not agree about the legislative particulars, or even the basic policy mechanisms a bill should rely on, many had fundamental disagreements about what the role of the government in the nation's health care system should be.

The House GOP's Obamacare replacement bill, which was finally released to the public last night after months of delays and secrecy, was, maybe more than anything else, an attempt to build party unity where none existed. It followed President Trump's endorsement of tax credits to provide coverage, an endorsement that GOP Speaker of the House Paul Ryan had sought as a way of bringing the fractured right together, and it appeared designed to address some of the concerns that had been raised about leaked versions of the bill with regards to Medicaid and tax credits for wealthier individuals. The bill was an attempt to find—or create—common ground for conservatives who agreed on little except that Obamacare should go.

That effort appears to have worked, albeit not in the way party leadership intended. The right has united—in opposition to the bill.

Nearly all of the major conservative activist organizations have come out against the plan. Heritage Action, which led the Obamacare fight that resulted in the 2013 government shut down and which often functions as a sort of shadow whip operation for House Republicans, called the bill "bad politics" and "bad policy." FreedomWorks (where I once worked) called it "Obamacare-lite," and Freedom Partners Chamber of Commerce said that "As the bill stands today, it is Obamacare 2.0." The Club for Growth dubbed it RyanCare and labeled it a "warmed-over substitute for government-run health care." All of these organizations have been deeply opposed to Obamacare from the beginning—yet none of them support the bill that GOP leadership has dubbed repeal.

It's not just the activist groups who have come out against it. Influential conservative and libertarian health policy wonks and journalists from all over the spectrum have trashed the bill too: Michael Cannon, the health policy director for the libertarian Cato Institute, called the bill "a train wreck waiting to happen" and warned that it could destabilize insurance markets even more than Obamacare while paving the way for single payer. Avik Roy, an influential health policy wonk who has crafted one of the more interesting conservative health care reforms, was brutal in his assessment of the law's likely effects: "Expanding subsidies for high earners, and cutting health coverage off from the working poor: [the GOP bill] sounds like a left-wing caricature of mustache-twirling, top-hatted Republican fat cats." Philip Klein of The Washington Examiner lamented that the bill rests on the same philosophical underpinnings as Obamacare, and will ultimately change little: "The GOP," he wrote, "will either be passing legislation that rests on the same philosophical premise as Obamacare, or will pass nothing at all, and thus keep Obamacare itself in place."

Cannon, Roy, and Klein are all staunch critics of Obamacare, but they all have different approaches to repeal and reform. The bill doesn't satisfy any of them.

And of course GOP legislators like Sens. Rand Paul and Mike Lee have voiced clear opposition as well. When asked about whether he would support the bill, Sen. Ted Cruz was non-committal.

These are not exactly pro-Obamacare voices from within the Republican party, to say the least. And yet they are not coming out in support of the repeal bill.The attempt to craft a compromise that all or most of Obamacare's critics on the right could get behind has, for all practical purposes, failed entirely.

In many ways, Boehner was right: The GOP has never agreed on health care. It still doesn't. But the other problem is that the bill doesn't really accomplish any of the things that Republicans say they want to accomplish on health care, at least not well. It's likely to disrupt coverage for millions of people. The tax credit, which is really a subsidy, is designed in a way that tilts the advantage towards people who are better off. It is likely to spin the individual insurance market into a death spiral even faster than Obamacare. The Medicaid rollback doesn't take effect for years, and, given the politics, might never go into place.

Indeed, given the widespread criticism, it's unclear who, exactly, this bill was written for—except, perhaps, a GOP leadership that wanted to be able to say they had developed something they could label a repeal bill.

Even President Trump, whose endorsement of tax credits for coverage last week was viewed as a necessary stepping stone for rallying Republicans around the bill, offered only qualified support, tweeting this morning that "Our wonderful new Healthcare Bill is now out for review and negotiation." He added, "ObamaCare is a complete and total disaster—is imploding fast!" Based on the reactions so far, the House GOP's repeal bill may be following the same path.

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  1. “It’s not known as ‘The Stupid Party’ for nothing.”

  2. TRUMP IS THE GREATEST DEAL MAKER IN HISTORY!

  3. The bill is DOA. So, there is no point in worrying about what is in it. When something actually gets passed and sent to conference committee is the time to take it seriously.

    1. That’s how Congress is gonna handle it, anyway.

      1. I have no idea how they are going to handle it. They only thing I can say with certainty is, however they handle it it won’t be with this bill in its current form.

        1. so we shouldn’t discuss/worry/think about language found in legislation that is not passed into law?

    2. The bill might be DOA, but whatever eventually passes won’t be dramatically different than the original proposal. All the subsidies, benefits, and existing medicaid coverage will be left largely intact. Only the method of payment will be tinkered with. For all intents and purposes, anything that gets majority of republican support (enough to override default opposition from democrats) will be a watered down version of Obamacare.

      The financial cost of Obamacare cannot be winded down with a single bill. The law has been in existence for almost 9 years now and millions of people are involved in it. For now, the focus should be on getting rid of the individual mandate, the penaltax and stabilizing the insurance market by reviving cancelled plans.

      If they do that, the public will slowly come around on reforming other areas of the law.

  4. “ObamaCare is a complete and total disaster?is imploding fast!”

    DEATH SPIRAL!

  5. I was told that all the Republicans were Trump’s toadies now. How can they oppose something that he likes?

    1. Backwards – he likes something they proposed.

    2. To be fair to Republican toadies, I’m not entirely sure Trump knows enough about healthcare to like or dislike their plan.

      Based on his campaign trail stances, his opinions of healthcare are: 1) universal coverage is good because mumble mumble … 2) Obamacare is bad because mumble mumble … 3) something something state lines

  6. So weird that they actually let everyone read what’s in it…..I thought we had to pass it to find out what’s in it?

  7. By the way, this is why you repeal ObamaCare before you enact a new bill.

    If and when the repeal gets bogged down in what to replace it with, ObamaCare will never be repealed.

    1. Repeal the mandate first, then go step wise from there.

      1. Right. Repeal with a deferred (but not long deferred) effective date, then let ’em play chicken on replacements.

  8. These idiots actually think a 30% surcharge is enough to make healthy young people buy insurance years before they need it?

  9. If no one can agree on how government should provide health insurance/care, maybe government shouldn’t be trying to provide health insurance/care. Just sayin…

    1. Look at you bringing logic into government!

    2. Listen up, someguy.

      The libertarian site is over th….

    3. Nah, I’m guessing the “no healthcare” option has an approval rating of about 1% among Congressmen (hi Amash and Massie!) and under 5% with the general public.

  10. These idiots actually think a 30% surcharge is enough to make healthy young people buy insurance years before they need it?

    That’s the question I’m looking for clarification on. Thanks for the hint.

    The biggest problem with Obamacare, aside from the big lie that insuring the poor is cheaper than treating them in community clinics and emergency rooms, is its mandate of actuarially indefensible premiums.

    Unless women pay women’s actuarial premiums, older people pay older people’s actuarial premiums, and young and healthy people pay young and healthy people’s actuarial premiums, health care law is constructed upon a foundation of sand, and it will fail in many and spectacular ways.

  11. Here is the problem…people like free stuff, politicians like their own egos and playing with other people’s money

    While it would be nice to get rid of it and govt out of healthcare, purity is not going to be reality here. At this point take what you can get even if it is just a lite version of Ocare.

    1. All of the major flaws of the ACA are also in the ‘lite’ version, so whats the difference?

      1. State lines
        No mandates
        Less taxes
        I think less standards for compliant plans, maybe? roll back some regs that drives paperwork

        but yea it isn’t good overall

  12. So it turns out that it was always just ‘repeal’ but RINO’s only heard ‘replace’ which fundamentally misunderstands the problem. Same as it ever was.

      1. If the GOP wasn’t monumentally stupid they would outlaw all insurance -except- for those who offer only catastrophic plans. Painful, perhaps, but no more or less painful for us than it has been trying to comply with the illegal ACA. The biggest idiocy? Anything they replace the ACA with, that people will ‘like’, will fail spectacularly only then the GOP will be blamed. Usher in the Democrats, and they’ll do something even more extreme than the last time.

        1. Yea or people will get tired of the pols fucking around in healthcare and will be skeptical of doing it yet again. i suspect if you get rid of the ACA, people will be pissed dems come in charge and demand singlepayer

        2. Better yet, stay out of market interference entirely. Don’t ban health coverage plans, don’t discourage them, don’t encourage them, don’t mandate them. Just stay the fuck out.

          Then, if they want to provide coverage by redistributing my taxes, do it the same way they provide welfare, food stamps, and every other subsidy.

          Stop trying to pretend health insurance is different from all other insurance. They don’t subsidize car insurance, or home insurance, or renter’s insurance. Welfare recipients provide that themselves out of their welfare. Add it to the welfare tab and let the recipients select their own.

        3. And yet, nearly all other democracies have settled into stable, shitty health policy. People obviously come to accept it.

  13. Trump is almost completely staying out of this. I think he sees what an unwinnable battle it is. Obama’s “You can keep your plan/doctor” would pale in comparison to the whoppers Trump would likely tell about any healthcare plan.

    Very few people want a completely capitalist healthcare system. That is just the world we live in.

  14. We need an Uber/Bitcoin moment in healthcare.

  15. The thing that always kills me about the healthcare debate is that the republicans NEVER speak to the real problems.

    If I were Trump, and perhaps only Trump is the type of “politician” who could pull this off, I would go out and say:

    “Look people, the truth is insurance as we’ve used the term with respect to healthcare in this country for the last few decades, is a scam. People’s idea of what insurance is IS the problem itself. What people need to do is go back to the old school model of health insurance. You buy catastrophic insurance, and then you save and invest for everyday expenses. We have this awesome tax advantaged thing called an HSA, you need to cancel your insurance tomorrow and sign up for one. You will save tons of money, and build a higher net worth for yourself and your family. If your company pays for your insurance now, tell them you want an HSA instead. Saves them money, makes you money. Win win.”

    Because that is THE ONLY way health insurance will ever work, make it actual insurance again.

    1. Other than that shit canning stupid regulations that hamstring the free market system from working would also help. Sell across state lines, allow importing drugs from abroad, make it easier for nurses or whatever to do basic stuff like write prescriptions for friggin’ ear aches meds etc. There’s a lot of little stuff, but getting rid of full coverage care is the big one.

      HSAs in many studies have been shown to INSTANTLY cut costs by around 20-30%. That’s within this broken system. If almost everybody went back to paying for everyday visits themselves the market would magically force hospitals and clinics to begin to compete on costs, which would surely drop prices a ton more. That combined with removing pointless regulations would create a proper free market which would function well.

      As far as the “poor” crowd, I guess just let them die or do Medicare for them or whatever? I think it’d be cheaper for us to just outright pay for all poor people and let the other 90% of the population do its thing within a properly functioning free market than to try to tie everybody together into a broken full coverage/HMO type system. I mean that’s how all other forms of welfare work in this country, so if nobody has the balls to cut those people off just do it like everything else and fund it out of the general budget.

    2. Whatever the case encouraging everybody to switch to HSAs is the answer. Whatever other dumb shit is going on in other parts of the system, HSAs will help everybody that uses them, so the greater the percentage of the population that uses that system the better.

      1. HSAs only come into their own when there are also enough reforms that move healthcare back towards a market. One where consumers can actually understand what they are purchasing.

        Otherwise they are just another subsidy propping up a lot of waste and inefficiency.

        1. Yes and no. They cut costs by 20-30% right off the bat, so there’s a positive even everything else being the same. As far as the tax dodge, so what? We’re overtaxed anyway. I wouldn’t call a tax dodge for a very valid purpose a subsidy. It’s not more a subsidy than a 401K or IRA is a subsidy. It’s tax policy encouraging good behavior.

          But yes, they would obviously be far better and have a far greater effect if other regulations were removed first… But cutting 20-30% right off the top, which would reduce paperwork shuffling (more direct pay=fewer claims to handle), and people actually paying attention to costs of a doctors visit to their GP etc is NOT going to hurt anything (they DO have cash prices, I’ve dealt with this personally), even without any reform other than the consumer changing their behavior.

    3. That’ll work politically if, & maybe only if it’s combined with what they did decades ago re hemodialysis: fund it by Medicare regardless of age. They need to do that for a few other expensive chronic conditions to buy their families’ votes. Not all pre-existing conditions, just enough to winning coalition, fuck you to the others.

  16. “The tax credit, which is really a subsidy, is designed in a way that tilts the advantage towards people who are better off.”

    People who are “better off” are also people who have something to protect, so an incentive might have more real effect if it is targeted at those sorts of people. So, speaking strictly on intention, it’s not a totally misguided idea.

    Not that that observation is in any way intended as a defense of the current proposal, which overall is a disaster.

  17. Pro, anti…this is all so much posturing at this point. They’ll work out something, we’ll make progress.

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  20. Paul Ryan and the republican establishment proving they are no more than Big Govt, democrats lite.

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