Stay the Course on the ACA
When the U.S. Supreme Court declined recently to expedite review of our Affordable Care Act case, justices accomplished two things. And both will help replace a failed system with something that works for American families. That’s why Republicans must stay the course and push ahead with Texas v. Azar, the lawsuit that could eventually scuttle the ACA.
First, the Supreme Court ensured that Democrats are stuck either defending the status quo—a failed health care “reform” effort that merely drove up prices without clearly resulting in better health outcomes (mortality rates, for example, haven’t budged)—or acknowledging its inadequacy by tossing it aside for a single-payer Medicare-for-All scheme.
In fact, it seems only former Vice President Joe Biden is willing to defend the ACA as a success, though he hedges his bets by allowing a “public option” explicitly left out of the ACA because it would have crowded out the private insurance preferred by most Americans. It’s not a strong argument. No one is happy with the current system; 69% of Americans rate the health care system fair or poor. Just 6% rate it excellent.
Even if Biden is the eventual nominee, the primary process is pushing him further and further left, and his public option closer and closer to Medicare-for-All. Already, unions, the voting bloc of the left, signal their opposition to this single payer option.
That leaves the Democratic field advocating—to one degree or another—a complete government takeover of the U.S. health care system. Medicare-for-All polls well, but only until people learn what’s in it. And following the primaries, the Democrats will have long weeks and months to explain how their planned takeover by government bureaucrats could ever result in less bureaucratic waste, lower wait times and stronger relationships between doctors and patients.
The Supreme Court’s decision means that Democrats will be forced to do just that. Continued focus on health care—voters’ No. 1 issue, according to polls—will erode the popularity of any version of the plan. In the long run, this means the likelihood of a quick legislative fix, even if Democrats win the White House, is lower. Chances are, we’re going to be dealing with the realities of the Affordable Care Act for years to come, unless we can defeat it in court—one more reason Republicans must stay the course with Texas v. Azar.
And that brings us to the second thing the Supreme Court decision does; it allows opponents to show Americans what a truly workable alternative to the ACA could look like.
For nearly a decade, Republicans successfully ran elections on repealing and replacing the Affordable Care Act. But after gaining control of both Congress and the White House, the party balked and failed to pass repeal or any meaningful reforms. The American people responded by throwing control of the House to Democrats and putting the President’s agenda in jeopardy.
The “repeal and replace” message is dead. Politically, it’s a non-starter. Complex legislation has no chance in the House, and Americans know this—and they’ll know empty promises when they hear them.
But Texas v. Azar provides a glimmer of hope to Republicans, now facing an entrenched ACA and a recalcitrant opposition party. Americans can repeal Obamacare, and with the reprieve granted by the Supreme Court, we can use this time to talk about alternatives.
Contrary to the prevailing narrative, Conservatives do have alternatives to the draconian mandates of the ACA. But it’s not a monolithic “TrumpCare” system; instead, it’s a series of reforms that bring back individual choice and personal control. The reforms include new ideas such as direct primary care (by subscription), paired with a safety net for Americans in need.
Republicans can talk about the simple economic principles—that less competition means higher costs and lower quality; that more choices means lower costs and better care. The GOP can point to price transparency, which is already revolutionizing the health care marketplace as consumers demand to know what they’re paying.
The fact is, no one will lose insurance if Texas v. Azar is upheld (and the ACA declared unconstitutional) by the Supreme Court in a future ruling. The insurance policies purchased through the exchanges won’t simply disappear; and states that expanded Medicaid are free to keep their existing qualification levels. In fact, states will be free to do whatever they wish with health care—to create their own single-payer systems, if they want.
Standing by the lawsuit now means that a second Trump administration will have time to craft even more policies designed to improve—not simply devour—the existing health care system. Republicans must stay the course—and not snatch defeat from the jaws of victory.
Robert Henneke is general counsel for the Texas Public Policy Foundation and lead counsel for the individual plaintiffs in Texas v. Azar.