Magazine article Reason

After Obamacare: The Long, Tortured Quest for a Conservative Health Policy

Magazine article Reason

After Obamacare: The Long, Tortured Quest for a Conservative Health Policy

Article excerpt

On January 19, 2011, in one of their very first actions after retaking majority control of the House of Representatives, Republicans voted to repeal the Patient Protection and Affordable Care Act, a.k.a. Obamacare. The vote was largely symbolic; no one expected the Democratic Senate to take up the measure. But for the House GOP, the repeal vote was the necessary fulfillment of the core campaign promise that helped sweep them back into power.

That promise, however, was only half fulfilled. Republicans had not merely vowed to remove Obamacare; they also said they would pass a program of their own in its stead. "Repeal and replace" was the mantra, and work on the second half of that slogan was to begin immediately. "We want to repeal today so that we can begin to replace tomorrow," Rep. Joe Barton (R-Texas) told The New York Times.

A consortium of House committees would be instructed "to begin work to construct an alternative health care vision" and create a "so-called replacement bill," Majority Leader Eric Cantor (R-Va.) told reporters. No specific timelines were laid out, but House Speaker John Boehner (R-Ohio) told the press that it would not be a drawn out process. "We expect them to act in an efficient way."

A year later, no replacement plan had surfaced. Republicans continued to insist optimistically that one was on the way. In January 2012, Rep. Joe Pitts (R-Pa.), head of the Energy and Commerce Committee, told a group of reporters that when the health law was adjudicated at the Supreme Court that summer, the GOP would have an alternative set to go. "We will be ready to respond to the Supreme Court decision, which is expected in June, with a replacement package," Pitts predicted. "We think that a free-market alternative is much better as far as making health insurance affordable and available to everyone."

The Supreme Court decision came and went; Obamacare survived. Republicans remained stuck on the first half of their repeal-and-replace pitch. The initial vote to get rid of the Affordable Care Act was followed by dozens more, each just as symbolic as the first. By August 2013, House Republicans had voted for repeal 40 times.

Obamacare's most consequential provisions --the health insurance exchanges and regulations on pre-existing conditions--were now about to take effect. As the October opening of the exchanges neared, congressional Republicans, at the urging of conservative activists, settled on an unlikely last-ditch gambit to stop the hated law: insisting that any measure to provide funding to keep the government open must not include funding for Obamacare.

The gambit failed, and it did so predictably. On October 1, the government shut down and the health-plan exchanges opened for business, spotty as they were. The shutdown ended two weeks later, leaving the Republican Party badly bruised in the polls and conservative activists at each other's throats over who was to blame. Far from uniting around an alternative, the GOP and its conservative base had split over the one health policy idea that was supposed to unite them all: taking down Obamacare.

For conservatives and for GOP legislators on Capitol Hill, the advent of the Affordable Care Act could have inspired a reckoning, a rethinking of how to lay the public groundwork for a post-Obamacare future. Instead, even as the ACA rollout fell on its face (see "They Lied," page 22), erasing the GOP's shutdown-triggered poll drop and battering President Barack Obama's approval ratings, uncomfortable questions remained: Is there a coherent Republican health policy? Is such a thing even possible in today's climate? Or is the political right only effective at saying the word "no"?

Looking for a Health Care Theory

The GOP's staunch opposition to Obamacare, combined with its unfulfilled promise of a replacement, has opened up the party to years of criticism that it has no health care ideas at all. …

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