What’s the Alternative?

Real Healthcare Reform by from The Weekly Standard, April 4, 2014

The crowing by the Obama administration over getting 7 million people to sign up for mandatory health insurance—with some portion actually paying for it—will soon fade. The big picture will remain clear: Obamacare isn’t working. And Americans, who didn’t like Obamacare when the Democrats passed it four years ago, don’t like it now, don’t want it to remain, and doubt it can be fixed. But they also don’t much want to go back to the pre-Obamacare world.

According to Real Clear Politics, a recent ABC News/Washington Post poll of registered voters was the 111th consecutive poll to find more opposition to Obamacare than support for it. That poll—which was more favorable to Obamacare than most—found 48 percent support for Obamacare, 50 percent opposition to it, and a 12-point deficit for it among those who feel “strongly” (27 to 39 percent). A recent Wall Street Journal/NBC News survey found that, by a tally of 49 to 35 percent, respondents judged Obamacare a “bad idea” rather than a “good idea.”

That same WSJ/NBC News poll, however, also asked whether people would vote for a Democratic congressional candidate “who supports fixing and keeping” Obamacare or a Republican candidate “who supports repealing and eliminating it.” By artfully joining “keeping” and “fixing,” while combining “repealing” not with “replacing” but with the redundant “eliminating,” the question suggested that repeal would mean a return to the pre-Obamacare status quo. In response, Americans were essentially split (48 to 47 percent, with the Democrat up 1 point).

So Americans are ambivalent about whether to try to “fix” this “bad idea” or simply eliminate it. But what they really want is for Obamacare to be replaced by something better.

Recent polling conducted by McLaughlin & Associates for the 2017 Project, with which we’re associated, substantiates this notion. The poll, in line with party affiliation nationally, included more Democrats than Republicans—37 to 32 percent—and it showed Obama’s approval rating at 44 percent, similar to other current polls. Its results for Obamacare were similar to the WSJ/NBC poll (41 percent approving, 54 percent disapproving).

But it also asked the following question:

Which comes closest to your view of the Patient Protection and Affordable Care Act, commonly known as Obamacare? 1. It should remain the law of the land, either in its current form or in amended form. 2. It should be repealed and replaced with a conservative alternative that aims to lower health costs and help people get insurance. 3. It should be repealed but not replaced with an alternative.

The responses show how important it is for Republicans to join repeal with replace: 32 percent preferred to keep Obamacare as the law of the land, whether in its current or amended form; 44 percent preferred repeal and the passage of a conservative alternative; and 16 percent preferred repeal alone. With an alternative—a conservative alternative—put into play, a clear plurality favored repeal and replace. And since the 16 percent who favored repeal alone would presumably easily accept a message of repeal and replace, it’s safe to say that “repeal and replace” commands the support of a large majority of Americans.

In other words, when Americans are given a choice between (a) keeping or “fixing” Obamacare and (b) repealing it in the absence of an alternative, repeal splits the electorate evenly. When they are given a choice between (a) keeping or “fixing” Obamacare and (b) repealing it in the context of a conservative alternative, repeal becomes a nearly 2-to-1 winning proposition.

Moreover, this is a Main Street majority. Among those who make under $40,000, Obama beat Mitt Romney by about 20 points (according to exit polling). Yet that same group favors repeal and replace by a 29-point margin (60 to 31 percent)—slightly more than the 27-point margin (60 to 33 percent) among those who make over $40,000.

All of this suggests that the key to ending Obamacare is for Republicans to advance a well-conceived alternative. It’s not enough to have House Republicans pass a smattering of piecemeal health bills. Americans want to know what the conservative alternative to Obamacare would look like in all.

Nor is it enough for Republicans to advance an alternative that (to quote the poll question) “aims to lower health costs” but otherwise doesn’t do much of anything to “help people get insurance.” In other words, a winning conservative alternative is unlikely to be one that relies on a tax deduction that offers very little to the near-poor who are almost the sole beneficiaries of Obamacare’s taxpayer-funded subsidies—and offers even less to those whom Obamacare has now added to the Medicaid rolls. Such an alternative would do little to help—it might actually make more difficult—the repeal of Obamacare.

The 2017 Project has advanced an alternative that is designed to bring about full repeal. It would end the unfairness in the tax code by offering a refundable tax credit for buying health insurance in the individual market—thereby providing a tax break that’s much like the one available to everyone in the employer-based market. It would solve the problem of expensive preexisting conditions by funding state-run high-risk pools and including a few commonsense regulations that would allow those, for example, who move from the employer market to the individual market to do so without getting charged more for a condition that was previously covered. It would save taxpayers money and make it possible for any American who wants to buy health insurance to do so. It would lower health costs by limiting the role of middlemen (whether insurers or the government) and by letting people shop for value. It would let Americans keep their plans if they like them, and in general respect their liberty. And it would repeal every last letter of Obamacare.

Polling shows Americans reject Obamacare. It shows they would prefer a conservative alternative to Obamacare. That preference should cause conservatives to take heart. Now they just need to take action.

© 2014 Weekly Standard LLC. Reprinted with permission.

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