After Senator John McCain’s Republican effort to repeal ObamaCare was thumbed down in 2017, the party’s leadership largely abandoned the effort and turned to other issues. Congress zeroed out the single-seat penalty as part of its tax-cut legislation; Republican attorneys general unsuccessfully used this action to persuade the courts to overturn the law; President Trump promised to replace ObamaCare with a better plan. Sens. Lindsey Graham and Bill Cassidy offered their own plan, but Republican leaders never put it to the test and seemed happier to forget the entire health issue.
Republicans need to be better prepared the next time they control both houses of Congress and the White House. President Biden’s plummeting poll numbers and Democrat power struggles could give them that opportunity three years from now. To avoid another failure to repeal ObamaCare, Republicans must convince voters that they have a viable replacement.
Liberals attack conservatives by forcing them to defend the worst aspects of the status quo, even though today’s dysfunctional healthcare system is a far cry from conservatives’ patient-centric system. Republicans should go beyond simply rejecting bad liberal health care reforms and offer their own reform vision. By now proposing a series of incremental conservative healthcare reforms, GOP lawmakers would increase their chances of success and provide a backup plan if they fall short again.
Offering standalone amendments on the next Democratic social spending behemoth would force swing district Democrats to choose between representing their constituents by supporting popular proposals or following their party’s radical leadership. Reforms can increase voters’ appetites for a more patient-centric health care system, just as limited grant programs and limited enrollment in charter schools led to sweeping school-choice legislation. Here are a few ideas:
• Expand access to telemedicine services permanently. During the pandemic emergency, Medicare waived site-of-origin and geographic restrictions. These regulations could be permanently abolished.
• Enable wider use of health savings accounts. These accounts allow patients to pay for expenses out of pocket with pre-tax dollars, giving them more control. Legislators could raise contribution limits, decouple high-deductible insurance accounts, codify coverage for supplemental preventive care services for chronic conditions, and reclassify direct primary care, in which the patient pays a flat monthly fee to a physician, rather than a bill for specific services, as a qualified Effort. Medicaid and Medicare should also be able to reimburse costs and contract with direct first responders.
• Remove rules that restrict health insurance options. Allow Americans to take out any health insurance plan approved by their state insurance commissioner, including disaster relief. Repeal the ACA’s employer insurance mandate and allow more flexibility to help employees afford health care services. Codify the Trump administration’s rules, which eased restrictions on healthcare reimbursement agreements, association healthcare plans, and short-term, limited-duration healthcare plans.
• Codify states’ authority to implement work requirements and modest premium and cost-sharing requirements into Medicaid. This would mean overturning the Biden administration’s recent actions and court rulings and allowing states more flexibility to transition their Medicaid programs toward premium support solutions and direct subsidies, and away from all-or-nothing unitary coverage.
At the state level, legislators should offer similar health care reforms. They should codify pricing transparency requirements, remove barriers to telemedicine adoption, allow small employers to pool resources to offer their employees group health coverage through health insurance plans, remove government restrictions on short-term, time-limited insurance, and allow alternative health services for membership-based organizations such as Farm Bureau Health Plans, expanding the ability of patients and physicians to use the direct primary care model, avoiding frivolous lawsuits and unnecessary defensive medicine, enforcing antitrust laws against the consolidation of health systems and plans, and increasing competition by de-certifying from Needs requirements that allow providers to practice to the extent of their training and allow for interstate medical license.
None of these reforms alone go far enough, and that’s the point. Democrats have steadily expanded government’s role in healthcare through decades of incremental steps culminating in ObamaCare. Republicans should use the same strategy to reverse course and empower patients over bureaucrats. Twelve years after ObamaCare was passed, Republicans’ goal remains to repeal and replace it. This will seem less of a risk to voters if successful steps in this direction have followed.
Mr. Jindal served as assistant secretary of health from 2001 to 2003, US representative from 2006 to 2008, and governor of Louisiana from 2008 to 2016.
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