Here is a question for Republican leaders – given that King v. Burwell offers both good and bad news which do you want first?
Americans are by nature positive. Let’s start with the good.
The good news is the U.S. Supreme Court may give Republicans an opportunity to advance a series of ideas improving healthcare that encompass cost-containment, personal responsibility, medical liability reform, and free market principles. A ruling against the federal government providing subsidies to individuals in states that have not set up exchanges through Obamacare will lead to a discussion on two important questions. First, do Americans want a patient-centered healthcare system? Second, what is the role of government to subsidize healthcare?
This brings us to the bad news. Voters have almost no confidence today that, even if they wanted to, President Obama and Congress could come to an agreement on real solutions for getting healthcare costs under control and increasing access to quality care.
There is no upside to dwelling on the negative so we’ll focus on a positive step President Obama and Congress can take. By granting carte blanche waivers and allowing state governments to take action, they will earn the overwhelming support of voters.
In research conducted by New Republican, voters in the swing states of Florida, North Carolina, Ohio, and Pennsylvania favor solutions implemented by their state governments with margins ranging from 72-76 percent in support to margins ranging from 19-20 percent in opposition. These are 4 of the 34 states that have not set up state health insurance exchanges and will be directly impacted if the current federal subsidies are taken away.
The findings are welcomed news to state leaders who don’t want to subject their constituents to the government-run Obamacare. As Republican leaders begin building support for meaningful healthcare reform, the research also offers insights into voters’ thinking that must be taken into account.
Overwhelming majorities (more than 75 percent) see a Supreme Court ruling resulting in some people losing the financial help they were receiving to afford insurance as a major or minor problem vs no problem. This view is shared by more than 65 percent of conservatives. A point that mirrors the research we have seen at GOPAC from other survey firms as we work with state leaders across the country on this issue.
To be clear, voters across the ideological spectrum favor their state governments taking action to make sure people keep the financial help they currently receive. Further, while most conservatives think it was a bad idea to rely on the Obamacare exchanges, they are open to state governments taking over and crafting solutions in order to keep premium costs from rising.
With Republicans having majorities in 69 of 99 state legislative chambers, there are unlimited possibilities for innovation and creativity to flourish. Every state is unique and the closer the government is to the people, the better the community’s needs are understood and met. This is not simply an ideological argument – the states have proven they are ready to lead on this issue.
In Florida, for example, state Representative Jason Brodeur is seeking to put in place direct primary care and expansion of ambulatory surgical centers. He has been in favor of consumer driven coverage by giving $2,000 annually to parents below the poverty line who don’t already qualify for Medicaid in exchange for an individual contribution of $25 a month. The funds would allow the consumer to purchase the health coverage products they need. Consumers would have the option to roll over any unused funds into the following year or transfer the money into a health savings account that they already control.
In New Hampshire, state Senator Andy Sanborn is pushing to allow for group plans where small businesses can create health buying co-operative associations. Further, he wants the state to provide tax credits to individuals who buy their health insurance.
In Wisconsin, state Senator Leah Vukmir is working with her colleagues to advance “integrated health agencies” in various regions across her state. This will encourage competition between healthcare providers, lowering costs for patients, while increasing the quality of care they receive.
While the Supreme Court may put pressure on lawmakers to help people afford their health care insurance, the final bit of good news is Republicans have the ideas and solutions to achieve it.
David Avella is Chairman of GOPAC and a veteran Republican strategist.