Comment | The GOP is playing catch-up on health care. Looking for some fresh ideas.


A few years ago, Republicans were clamoring to repeal the Affordable Care Act. Today, opposition to the bill not only misses the party’s message, but some Republican states like North Carolina are using it to expand Medicaid. He did this week.

This is a clear example of how far the party has come — and the need for a new conservative way of thinking on health care.

Repealing Obamacare was a rallying cry for Republicans for years until the party took full control of federal laws in 2016 with Donald Trump’s victory. They could not do this Amazing fashion In the year In 2017, three GOP senators opposed even a slim bill that would raise the tough questions of repeal before a House-Senate conference committee.

At the heart of the GOP’s failure is its unwillingness to address the real issues that repeal would cause. For better or worse, millions of people have become dependent on Obamacare through national health insurance subsidies or Medicaid expansion. The health care industry began to restructure in response to some of the law’s non-public actions, such as deregulation. Accountable care organizationsBringing doctors and hospitals into closer coordination. Seven years after Obamacare was passed, the GOP has not figured out how to approach the challenge of rolling back these provisions.

This has led Republicans to play primarily on health policy. Ten states It remains on hold over Medicaid expansion, but North Carolina’s move means almost everyone will now expand the program. Georgia Governor Brian Kemp (R) a Limited expansion In his state, the program would allow coverage for individuals earning up to the federal poverty threshold, which fellow swing state Wisconsin already does. That leaves only a handful of deep red states, mainly in the South, with pre-Obamacare Medicaid laws.

This slow movement reflects an ideological shift among voters. Seven states Over the past five years, they have approved Medicaid expansion through ballot initiatives, including Republican sites such as Nebraska, Oklahoma And Missouri. South Dakota became the most recent red state to do so last November. 56 percent of regional voters He supported the movement. Republican Governor Christy L. Nome, who opposed the idea, won re-election 62 percentIt shows that many staunch Republicans favor expansion.

That leaves Republican officials in a quandary. Large numbers of voters nationwide, including most swing voters; Supporting broad public subsidies For health care. But party activists and donors are at best in denial and at worst hostile to this reality. In recent years, Republican officeholders have responded by doing as little as possible to avoid angering both.

The best approach is to accept what people have and work with it. That means thinking about tough questions that many will vote on, such as reforming subsidies and how health care providers are managed.

Conservative health care policy experts have many ideas to offer. Most support more regulation and market forces to improve health care delivery and efficiency, allowing health insurance coverage to expand without breaking the bank. For example, James Capreta of the American Enterprise Institute has been beating this drum for decades and recently edited it. Universal size Recommendations on this line. Manhattan Institute Chris Bishop Similarly, the idea that the party is helping to shape a new agenda is health care.

The party should think hard about who deserves public subsidies to buy health insurance. Most people agree that those who can afford health insurance should not receive public assistance. But the current policy does just that. Private health insurance premiums paid by employers are exempt from income tax, and Medicare Part B premiums are heavily subsidized no matter how much seniors have in the bank. Fiscal conservatives and populists must agree that taxing the working class to pay for the health care needs of wealthy retirees is bad public policy.

Making this change in health care will help the party renew itself in other areas as well. Americans, including large numbers of Republicans, want a broad welfare state. They want well-funded public education, subsidized medical care, and a secure retirement program. They are at risk when reforming programs that stand in the way of the conservative goals of small government. But they want innovation and private sector opportunity.

A healthy Republican Party embraces that combination of choices and focuses on delivering the goods. Voter support for Medicaid expansion should prompt the party to acknowledge that reality.

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