Now that a Republican-controlled Congress is finally on the brink of repealing and replacing the Affordable Care Act, it can be easy for conservatives to get lost in the celebratory noise. After all, the GOP’s longstanding rallying cry to toss out Obama’s signature policy comes at the end of years of legal and rhetorical struggle.
But as James Capretta of the American Enterprise Institute argues, this should not be a moment for cheers and jeers. Rather, conservative policy leaders should take a moment to pause and reflect on what the end goal of this struggle was all about in the first place.
“The starting point for this effort ought to be that everyone in the United States should have health insurance, protecting them against major medical expenses,” he writes.
And in a marketplace where “only the very rich can pay for [certain treatments] without health insurance,” Capretta argues that providing citizens with cheap access to such insurance is vital, even if certain politically unsavory measures must be utilized.
But Capretta makes plain the need for a comprehensive viewpoint when dealing with such a massive challenge.
“Conservatives have a once-in-a-generation opportunity to advance a market-driven approach to health insurance reform that provides secure and affordable insurance to all Americans,” he writes. “They should embrace the challenge.”
“They must also understand that voters and history will judge them to have failed if the end result is millions of people becoming uninsured again,” he adds.
So with that in mind, Capretta lays out four major steps the GOP should take in its replacement plan to increase the numbers of Americans enrolled in health insurance.
Grandfather Coverage Provided by the ACA. This will give people a natural transition between the ACA and its replacement plan, Capretta argues, which would also ensure the market remains stable during said transition.
Accept and Clarify Medicaid’s Role as the Safety Net Health Insurance Program. With 61 million non-disabled low-income adults and children currently enrolled in the Medicaid program, Capretta writes that states need more flexibility to run the program efficiently and to integrate Medicaid insurance more carefully with the private insurance market. As such, the “GOP should seek to establish a new, uniform eligibility level for Medicaid nationwide that is somewhere between the ACA expansion limit and the levels prevailing in the 19 states that did not expand the program.”
Impose Cost-Discipline and Generate Revenue with an Upper Limit on the Tax Preference for Employer-Paid Premiums. This will be politically tricky, but Capretta writes that the GOP must press forward with it anyway, “as the policy is critical for establishing more cost discipline in the employer-provided market and for the revenue that it will generate to finance an adequate tax credit” for everyone else who’s not in the employer system.
Build an Effective Auto-Enrollment Program to Achieve Higher Levels of Coverage. In other words, make is so easy to sign up that people don’t even have to do anything (and make sure the websites work, something the Obama administration seemed to forget about back when the ACA rolled out).
“Republicans have a rare opportunity in 2017 to make big changes in health policy, but they must understand that providing secure insurance for everyone in the country needs to be a central feature of what they do,” Capretta concludes. “That is not an unreasonable demand, nor is it an impossible task. What’s needed is determined leadership from those who are about to become responsible for governing the country.”
You can read Capretta’s full column at Real Clear Health.
Evan Smith is a Staff Writer for Opportunity Lives. You can follow him on Twitter @Evansmithreport.