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The Road to Repeal

May 26, 2014, Vol. 19, No. 35 • By JEFFREY H. ANDERSON
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It's a question often asked these days in conservative circles: Do you really think Obamacare can be repealed? Usually uttered behind closed doors, the question reveals both an un-Reagan-like pessimism and something of a disconnect from political reality.

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Obamacare was profoundly unpopular when the Democrats went ahead and passed it anyway, daring the American people to make them pay. Voters responded by removing more Democrats from congressional seats—69 between the two chambers—than they had since before Ted Williams first donned a Red Sox uniform, in the spring of 1939. In 2012, the failed Republican presidential-selection process yielded a nominee who didn’t make Obamacare a central issue and later called it “very attractive.” He lost despite Obamacare’s continuing unpopularity, which was indicated by exit polling. Now that Obamacare has finally gone into effect, its combined impact on Americans’ health insurance, their health costs, and their personal freedom—not to mention the nation’s solvency—has been far worse than its supporters advertised and possibly even worse than its opponents predicted. In response, President Obama has refused to implement the legislation as written, unlawfully altering parts of it as if he were a one-man Congress. Meanwhile, the 123 polls taken on Obamacare during his second term (according to Real Clear Politics) have all found it to be unpopular, with more than two-thirds of those polls—and 8 of the 10 most recent polls—showing approval deficits in the double-digits.

So—yes—Obamacare can, should, and must be repealed. America’s future as a nation of liberty, prosperity, civil society, and laws depends on it. Indeed, given its unpopularity, the question should be: How can Obamacare not be repealed?

What’s more, Republicans, as the party of limited government, not only have an obligation to repeal Obamacare but would benefit politically from doing so. More specifically, they would benefit politically from putting forward the alternative to Obamacare that is the key to achieving its full repeal.

Americans are eagerly awaiting such a conservative alternative. A recent poll by McLaughlin & Associates asked, “If the Republicans were to propose a new plan of their own to improve health care by repealing and replacing Obamacare would you be more or less likely to vote for a Republican for Congress?” By a margin of 31 percentage points (48 to 17 percent), likely voters said they’d be more, not less, inclined to back a Republican in that event. Moreover, that margin was at least 25 points among independents, Hispanics, those under 40, those who make less than $60,000, and women—groups the GOP is supposedly courting.

On the generic congressional ballot, the McLaughlin poll showed Republicans trailing Democrats by 2 points among likely voters—43 to 41 percent. But the poll also asked whether likely voters would be more apt to support for Congress a “Republican who wants to repeal and replace Obamacare” or a “Democrat who wants to keep and fix Obamacare.” By a tally of 47 to 43 percent, respondents picked the Republican—a 6-point swing in the GOP’s favor (from 2 points down to 4 points up). That swing from the generic congressional ballot was even greater among independents (13 points in the GOP’s favor), Hispanics (7 points), those who make under $60,000 (7 points), and women (8 points).

Earlier McLaughlin polling, commissioned by the 2017 Project, is similarly revealing. When asked their “view of” Obama-care, only 32 percent of respondents said “it should remain the law of the land, either in its current form or in amended form”; 44 percent said they’d rather see it “repealed and replaced with a conservative alternative that aims to lower health costs and help people get insurance”; and 16 percent said they’d rather see it “repealed but not replaced with an alternative.” Thus, with a conservative alternative in play, support for repeal beat opposition to repeal by almost two to one (60 to 32 percent).

Any such conservative alternative, however, will be judged in two key ways: What will it do for the poor and the near-poor who are almost the sole Obamacare beneficiaries, and will it be disruptive in any other way?

At great expense and at great disturbance to people’s existing doctor-patient relationships, Obamacare has managed to increase the number of people with health insurance. True, many if not most of those people were merely dumped into a failing Medicaid program at taxpayer expense, and many if not most of the rest were coerced into buying mandatory Obamacare-compliant insurance against their will. Still, millions of additional people are now insured, millions more will become insured by January 2017, and Republicans are going to have to make clear that those millions would continue to have access to insurance under a conservative alternative. At the same time, such an alternative should not cause turmoil by changing the tax treatment of health insurance for most people in the employer-based insurance market. A conservative alternative that enables anyone who is insured to remain so and anyone who wants to become insured to become so, and which doesn’t disrupt the typical American’s employer-sponsored insurance, would be a political and policy winner, and would enable the repeal of one of the worst pieces of legislation in American history.

The 2017 Project has advanced one such alternative. It would not allow people to be kicked off, or charged higher premiums for, their existing insurance—including insurance bought through the Obamacare exchanges—because of preexisting conditions. It would end the unfairness in the tax code by offering refundable, non-income-based tax credits to anyone who buys insurance in the individual market. These tax credits ($1,200 for those under 35 years of age, $2,100 for those between 35 and 49, and $3,000 for those 50 and over—plus $900 per child) would enable people to buy insurance even if they supplemented the credit with no more than $15 a month of their own money, according to the federal government’s own figures on the price of insurance on the eve of Obamacare. These credits would do so, that is, except in five liberal Northeastern states that have ruined their insurance markets through hyper-regulation—but people who live in those states could escape by buying across state lines. Those with expensive pre-existing conditions would be able to get insurance through federally funded, state-run high-risk pools, from which no one could be turned away or charged a premium he or she couldn’t afford. To further equalize the tax treatment of the employer and individual markets, the tax exclusion for employer-sponsored insurance would be capped at $20,000 for a family plan, far above the level at which the typical American would be affected at all. (Even those with premiums over $20,000 would still get the full tax break on that first $20,000.) Moreover, all of this would cost about half what Obamacare would cost—and much of that “cost” would come in the form of an overdue tax cut for middle-class Americans—saving taxpayers about $1 trillion over a decade.

Such an alternative would pave the way to full repeal. Without such an alternative, however, Obamacare will almost surely survive—for when one political party offers something and the other offers nothing, Americans almost always choose something. So the real question worth asking is not whether Obamacare can be repealed, but this: Are Republicans serious enough about repeal to advance a winning alternative that can make repeal a reality?

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