The Magazine

Delay, Repeal, Replace

The Obamacare fight has just begun

Feb 4, 2013, Vol. 18, No. 20 • By JAMES C. CAPRETTA and JEFFREY H. ANDERSON
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This would be a popular pitch for Republicans to make to the American people: We will cut the deficit by $200 billion and will also keep you from having to live under Obamacare for another two years. That’s a win-win for the American people. As such, it’s a pitch congressional Republicans should make​—​and it’s a price its members should make Obama pay to get what he wants in the budget process.

Delaying the implementation of Obamacare would be important for three reasons: It would save hundreds of billions of dollars in federal spending. It would spare Americans from having their health care premiums spike until a somewhat later date. And it would move the onset of Obamacare much closer to the 2016 presidential election, which would put Obama’s centerpiece legislation at center stage in that race​—​as the future health of the nation demands that it be.

Of course, this is the last thing that Obama wants, but he may not have much choice in the matter. Once a possible delay gets floated by Republicans in Congress, it could gather momentum. Many governors, including some Democrats, are likely to support such a move because they see a train wreck coming in 2014 and are eager to avoid it. Moreover, many businesses, including insurers, would support a delay because they know the government is not remotely ready to implement Obamacare on schedule. Even a one-year delay would pay dividends in all of the ways listed above.

Beyond resisting and delaying the implementation of Obamacare, the most important thing for the GOP at this point is to develop and unite behind a practical replacement proposal​—​one that will actually solve the very real problems plaguing American health care. While Obamacare’s failings will undoubtedly further energize popular opposition in the years after its implementation, that opposition alone is unlikely to be strong enough to result in its full repeal in the absence of a plausible replacement. Americans want reform of some sort to address the issues of preexisting conditions, rapidly rising costs, and unstable and insecure insurance for tens of millions of their fellow citizens. Obamacare’s opponents can win this fight​—​but only if they’re willing to do the hard and often complex work of developing an alternative that offers solutions to these concerns without imposing Obamacare’s excessive costs and heavy-handed governmental controls.


A credible alternative to Obamacare must start with a plan to address the issue of preexisting conditions. As matters stand today, it is possible for families to stay continuously insured and yet, when moving from employer-provided insurance to the individual market, still face sky-high premiums because a child has a genetic condition or a spouse has battled cancer. That strikes most Americans as fundamentally unfair. Fixing this problem, however, does not require a full federal takeover of the health system. New regulations, recommended federally but implemented by the states, could give Americans new protections if they stay continuously insured. In practical terms, Americans should be able to move seamlessly between employer-based coverage and individually owned insurance without being subjected to high premiums based on the development of a costly health condition. Making this work will require additional funding from the federal government for state-based high-risk pools. As for those who haven’t remained continuously insured, a onetime buy-in could allow them to purchase insurance at below-market price, with high-risk funding being used to offset part of those costs.

Of course, to stay continuously insured, families need to have realistic and affordable options. This, in turn, requires fixing the unfairness in the tax code. Since World War II, the federal tax code has been heavily biased toward job-based insurance. As a result, those without access to employer plans have a very difficult time finding affordable insurance. In reforming the insurance market, Republicans should end the tax code’s discrimination against those outside of the employer-based system. There’s no reason why Americans who get their insurance through their employer should get a tax break, while those who buy it on the open market should not. To address this unfairness, a replacement to Obamacare should provide a tax credit to households that don’t have access to tax-subsidized, employer-based coverage. Such a credit should be equal to about $2,500 for individuals or $5,000 for families and could only be used to offset the costs of health insurance premiums or deposited into a health savings account. By adopting such reforms, Republicans would fix what the federal government broke, rather than giving it control of the entire health care system.

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