Can Republicans Regroup on Health Care?

ObamaCare returned to the Supreme Court this month and the law seems sure to survive a legal challenge from GOP state attorneys general. That lawsuit has long looked like a futile exercise, and the real question for Republicans is: How many elections will the party lose before coming up with a potent political argument on health care?

For all the Republican success in Senate and House races, health care continues to haunt the GOP. John Hickenlooper, the Colorado Democrat who defeated GOP Senator Cory Gardner, set up the subtly named CoryGardnerWontProtectPreexistingConditions.com. Many others pounded the GOP as wanting to snatch away health insurance from Americans during a pandemic. Arizona Democrat Mark Kelly cut an ad touting himself as a defender of the vulnerable featuring a mother of a child with a heart defect.

This playbook helped Democrats win the House in 2018, and you can bet they’ll reprise it in the January Senate runoffs in Georgia, where Democrat Jon Ossoff is running on defending the Affordable Care Act. “I want to live in an America where every family has great health care,” he tweeted recently, as if anyone disagrees with this bromide.

Yet after trying and failing to replace the Affordable Care Act in 2017, the GOP seems more or less resigned to defeat on health care. At least a narrow Republican Senate majority could prevent a President Biden from passing a “public option,” the thinking goes. But that is merely a stay of execution until the next time Democrats control government. About two-thirds of Americans support a government plan that competes with private insurance, according to a January Kaiser Family Foundation poll.

One reason that idea is popular is that Republicans have struggled to explain how a public option would exploit unlimited taxpayer financing to cannibalize competing insurers and move ever more Americans from generous employer insurance into plans that look like Medicaid. Some two-thirds of Americans who support Medicare for All (single payer) wrongly thought they’d be able to keep their current health insurance, Kaiser reported in October.

These polls suggest that what Americans really want isn’t single payer. They want protection from the risk that they or someone they love needs help paying for cancer immunotherapy or surgery. There is a political opening for policy that covers costs for the sick without compromising medical innovation or prompt access to care, and favors choice and competition over mandates and political control.

For instance: The Affordable Care Act’s subsidies function as transfers to insurers, not to patients racking up medical bills. Give the subsidy money to states to spend on those with pre-existing conditions through “high risk pools” or other arrangements. The Affordable Care Act’s mandates on benefits also preclude specialized plans for, say, diabetics or cancer patients. Allowing tailored options would better serve those with pre-existing conditions who are currently trapped in ObamaCare’s high deductibles and narrow doctor networks, as policy analyst John Goodman has written.

Under ObamaCare’s Medicaid expansion, the feds paid states more to enroll prime-aged men above the poverty line than to cover the truly needy—even as Democrats claim to be the party of compassion. Republicans should broadcast that message across the suburbs and vow to correct the dysfunction.

The GOP also needs to think bigger than the individual market, which is not where most Americans are insured. Federal rules permit tax-preferred health-savings accounts to be paired only with plans that have a high deductible. Why not allow more Americans to control more of their own health-care dollars? Other good ideas include supporting direct primary care that offers preventive services for a low monthly fee, or improving reimbursement for telemedicine.

These and other ideas can be found in a recent policy blueprint produced and supported by center-right policy minds like Mr. Goodman, Grace-Marie Turner, Brian Blase and Doug Badger. They deserve credit for continuing to push this rock up the hill even without many champions in Congress. Republicans have lost muscle memory on health care with the departure of members like Tom Coburn and Paul Ryan.

So far what Republicans have tried is writing bills on pre-existing conditions registering their agreement with Democrats on preserving ObamaCare’s mandates. Few have bothered to point out that only 2.7% of an estimated roughly 130 million people with pre-existing conditions gained access to health insurance through the Affordable Care Act.

It’s true the press will help the left disparage every Republican idea. But a public option that was too radical to pass as part of ObamaCare is now the moderate position in the Democratic Party, and the party’s goal remains a government monopoly on medical care. Republicans owe it to the country to be more than speed bumps on the road to single payer.