Good news for conservatives across the country: Congress has approved a 2017 budget resolution, setting into motion the process of repealing the Obamacare law. The vast majority of Republican legislators took an affirmative and laudable step toward fulfilling the promise of a system of patient-centered health reform by repealing the onerous law.
Still, there is much work to be done. While the budget resolution gives instructions and provides a vehicle to allow for repeal without facing a filibuster threat, some Republicans continue to express concerns about moving forward without a full replacement plan. Furthermore, some uncertainty remains as to what, exactly, will be able to be repealed through reconciliation, given Senate rules.
The 2015 reconciliation bill passed by Congress repealed certain parts of Obamacare, but left others intact (and was eventually vetoed by President Obama). This allowed Congress to bypass debates over whether other portions—specifically, the insurance regulations—could repealed under that procedure. While some continue to maintain that provisions not directly related to taxes or spending cannot be included, it is important to note that those questions were never adjudicated during the 2015 negotiations. Now is the time for Congress to litigate that question, and they should include the repeal of the insurance regulations if possible.
But, even if including the regulations through reconciliation proves impossible, Congress should at least move forward with repealing the measures that were included in the 2015 bill. That bill demonstrated that, at a minimum, the deeply unpopular individual and employer mandates, virtually all of the taxes associated with Obamacare, and many other provisions have been ruled budgetary and repealable via the reconciliation process. A bill that leaves insurance regulations in place, however, would need to be quickly followed by legislation repealing them, given that these regulations directly contribute to the rising costs of health insurance many are experiencing, and, without further action, partial repeal will likely result in more widespread loss of coverage. Handled correctly, Congress has a great opportunity to reform health care such that it meets the needs of the American people, addressing their concerns about rising health care costs and access to quality care.
Some have argued that repealing parts of Obamacare without a robust replacement plan could have harmful political consequences for Republicans, especially if a partial repeal leads to a destabilization of the insurance marketplace. Those arguments are not frivolous, but they pale in comparison to the concerns associated with failing to act quickly. As James Wallner of the Heritage Foundation has compellingly argued, waiting for a consensus on a replacement plan “actually poses greater political risk for the GOP, makes repeal less likely, and ensures that the replace debate will occur in the context of the framework created by Obamacare.” In other words, without a repeal of the law, the debate about how to go about replacing it will be constrained by the baseline established by Obamacare. It will also risk demonstrating to Republican voters that, despite a unified Republican government, Republicans are not committed to repeal. If Congress fails to act on repeal now, it is likely that Obamacare will remain the law and will therefore function as a baseline, rendering later efforts to pass needed fundamental reforms of the health care system more difficult.
And to be sure, there are a number of fundamental reforms that need to be implemented if the American health care system is to be fixed. Congress can work on finding healthcare solutions that work better for people after lawmakers agree to the budget reconciliation package that repeals Obamacare. For example, incentivizing more and easier contributions to health savings accounts, enabling easier direct payment of primary care, removing barriers created by certificate-of-need laws, expanding treatment delivery options such as telemedicine by reducing regulations.
Congress took the important first step last week, and it should keep the momentum going. Otherwise the actions of grassroots activists would be in vain. Obamacare is collapsing under its own weight, and only Congress, acting in concert with a willing president, can act to repeal it.
Conservatives must not miss this opportunity.