How Republicans can still reform healthcare


The failure to repeal and replace ObamaCare was a political debacle for Republican leadership. But, despite the recriminations, there is still a way for them to grab victory from the jaws of defeat.

The House healthcare bill failed because it was too complex, combining too many controversial provisions. Its sponsors didn’t spend the time or make the effort to explain, in clear terms, how it would work.

Most voters neither trusted nor understood it. When a bill turns off conservatives, moderates and liberals, somebody needs to start over.

A Quinnipiac University poll showed that only 17 percent of voters supported the Ryan plan, with only 14 percent of independents favoring it. Another poll by PPP, a Democratic-oriented outfit, found that only 55 percent of Republican voters, 32 percent of independents and 5 percent of Democrats would prefer the GOP House leadership’s American Health Care Act over ObamaCare.


So what do Republicans do now? Should they let the whole issue die and then blame Democrats for the consequences, as President Trump mischievously suggested?

It’s up to them, of course. But that strategy is loaded with pitfalls, in addition to cold-blooded cynicism.

For starters, it doesn’t give GOP voters what they were promised. A new Reuters poll shows that 80 percent of Republicans still want to repeal ObamaCare.

The other problem is that ObamaCare may not implode and, even if it does, it may not be a Big Bang. It may happen in slow motion over years, and that would destroy the political rationale for the strategy.

Republicans need fresh thinking. Instead of throwing everything into one, big, complicated, hard-to-understand healthcare reform bill — as has been the practice since President Bill ClintonBill ClintonHow Republicans can still reform healthcare Chelsea Clinton dismisses rumors she’ll run for public office: report Trump seeks to stop lawsuit from ‘Apprentice’ contestant MORE and first lady Hillary ClintonHillary Rodham ClintonYes, Marine Le Pen can win in France. Here’s how. How Republicans can still reform healthcare Grassley asks State for details on Clinton’s security clearance MORE tried that in the early 1990s — they need to streamline their tactics.

A smart approach for them — one that gives the GOP base what it wants and follows a sensible route to getting there — is to split ObamaCare repeal from replacement, and then to propose multiple, single-object bills to handle replacement issues.

The first step would be to repeal ObamaCare as soon as possible, but to push back the effective date of the repeal to a year from now. This gives Congress time to shape, sell and pass legislation to smooth the transition from ObamaCare and to open the door for new ideas, including free-market approaches that conservatives have always wanted.

The next step for the GOP leadership would be to introduce a package of separate — emphasis on “separate” — bills that tackle a range of replacement issues. One bill, for example, could continue the policies for preexisting conditions and dependents up to 26 years of age, the prohibitions on lifetime insurance limits, and the restrictions on charging older Americans more.

Democrats would be hard-pressed to vote against these wildly popular provisions that they have supported in the past.

A second bill could expand health savings accounts, which is something Republicans have advocated. A third bill could deal with subsidies for premium and out-of-pocket medical expenses, perhaps offering tax credits to offset some of them. A fourth could deal with Medicaid expansion.

It would be good for Congress to vote up or down on each of these proposals. It would sidetrack the blame game and draw clearer, more understandable policy lines. It would also extract both Republicans and Democrats from the single “all-or-nothing” box that ObamaCare put them in and Ryan’s bill perpetuated.

Most importantly, it would likely produce the best policies for healthcare.

By dividing replacement of ObamaCare into separate issues, it may also bring Democrats into the process and make both parties more responsible for the outcome. Republicans would benefit by disrupting the Democratic strategy of killing everything with a Trump or GOP label. Democrats, especially senators who face reelection next year in states that voted for Trump by wide margins, would benefit by not having to always be the party of “no.”

Admittedly, drafting separate bills on these often-related issues would not be an easy task, but it can and should be done.

After this plan is set in place, the GOP would need to mount a major public information campaign explaining them. As former Speaker Newt Gingrich has wisely advised, “The number one goal of any health reform must be to communicate with the American people and convince them this will provide a much better future than the current system.”

Whether you agree or not with either side’s policies, this cleaner and simpler approach would break the mold of business as usual and show that Congress can get something done.

If the legislative process can’t be perfect — and it won’t ever be — it should at least be logical.

Ron Faucheux is a nonpartisan pollster, political analyst and publisher of, a daily newsletter on polls. He has authored or edited six books on politics, including “Running for Office: The Strategies, Techniques and Messages Modern Political Candidates Need to Win Elections,” (Rowman & Littlefield, 2002) and is president of Clarus Research Group.

The views of contributors are their own and not the views of The Hill.

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How Republicans can still reform healthcare

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