Chris Jacobs asks at National Review Online about the Affordable Care Act’s future.
For the past six years, Republicans — across Washington, and across the country — have virtually to a person run against Obamacare. Their campaign has helped them win numerous House and Senate seats, a majority of governorships, and now has given them unified control of Washington for the first time in 15 years. Like the dog that finally caught the proverbial car, Republicans will wake up … asking themselves — on Obamacare, as on many other issues — “What now?”
The answer might be less obvious than it first appears. Democrats used the decade and a half between the defeat of Hillary Clinton’s health plan in 1993–94 and the 2008 election to develop a consensus architecture about what their ideal health-care plan would look like. In the Democratic primaries that year, Senators Clinton and Obama disagreed strongly on the necessity of an individual mandate to purchase coverage — a difference they litigated very publicly, and at great length, during the primary campaign — but agreed on virtually everything else.
By contrast, Republicans spent comparatively little time debating the finer points of an Obamacare alternative during the presidential cycle just concluded. Donald Trump promised “something terrific” that would tear down “the lines around the states,” but details were few and far between (and occasionally self-contradictory). Speaker Ryan’s House Republican task force produced a plan, but one with few fiscal details attached, and one that few in Washington — whether media analysts or policy-makers themselves — spent time dissecting or debating.
As a result, Republicans differ on some fundamental issues — chief of which is whether an alternative to Obamacare should focus on lowering costs or expanding coverage. While conservatives have historically focused on reducing costs, some on the right have argued that any alternative to Obamacare must provide a landing point for the individuals who gained health coverage under the law. Others have dubbed any alternative plan including mechanisms such as refundable tax credits to expand coverage “Obamacare Lite” — a term likely to resurface with a vengeance in the coming days and weeks.
