Health Care

Republicans Didn't Lack a Plan to Replace Obamacare. They Lacked a Unified Theory.

The GOP never quite figured out how to think about broad health care goals.


As Republicans move towards a vote on a bill to rewrite Obamacare later today, it's worth looking back at why their last attempt at a vote, in March, crashed and burned at the last minute.

In a piece for Reason's print edition, I argue that the GOP's problem isn't a lack of a plan, it's a lack of a unified theory, a way of thinking about what health policy goals the party should favor, and what sort of process it should use to achieve those goals.

Here's an excerpt from the piece:

There has never been a shortage of GOP substitutes for Obamacare, from think tank white papers to congressional committee frameworks to fully drafted bills. But in the seven years that congressional Republicans spent promising to repeal and replace President Obama's health care law, none ever moved beyond the development phase, because what Republicans lacked wasn't a plan. It was a theory.

After the Affordable Care Act (ACA) passed, when Republican legislators were asked what sort of health system they preferred, most would say something about lowering costs, increasing affordability, and improving access. Some might criticize Obamacare for covering too few people, as Senate Majority Leader Mitch McConnell did in January. "What you need to understand is that there are 25 million Americans who aren't covered now," he said on CBS News. "If the idea behind Obamacare was to get everyone covered, that's one of the many failures."

But improved affordability and accessibility is an outcome, not a system. Republicans almost never took the time to describe the basic mechanics of how their preferred health care system might work. As a result, when the GOP took control of both Congress and the White House this year and the time came to draw up an actual plan to repeal and replace the ACA, it struggled to get out of the gate. Proposals were repeatedly altered and delayed. After the House repeal bill was released in March, it was met with an immediate chorus of criticism—with the loudest voices coming from the right.

Read the whole thing.