Wimping Out on Obamacare?

Obamacare by from The Weekly Standard, January 9, 2015

Republicans have now won two Obamacare elections, the first in 2010 and the second in 2014. (In 2012, their presidential nominee chose not to engage on the issue.) In the lead-up to their latest victory, Republicans ran far more ads against Obamacare than either party ran for or against anything else. Voters responded by giving the GOP 9 more Senate seats and 13 more House seats. The one candidate who ran on a genuine alternative to Obamacare, Ed Gillespie in Virginia, almost pulled off the upset of the night. Predicted by polls to lose by nearly ten percentage points, he lost by less than one.

One would think such resounding results would have given Republicans renewed confidence in pursuing repeal and reinvigorated interest in uniting behind a conservative alternative to pave the way to that repeal. One would expect the election to have reaffirmed the party’s long-held position that the “comprehensive,” 2,700-page overhaul of American medicine shouldn’t be “tweaked,” “fixed,” or “repaired,” but comprehensively repealed. That is, after all, what rank-and-file Republicans and a great many independents surely had in mind when they cast their ballots for GOP candidates.

Unfortunately, the early signs suggest that House and Senate Republican leaders think voters sent them to Washington to make Obamacare better—on the margins, in ways that appeal to corporate interests. At a time when neither political party is doing a very good job of standing with everyday Americans, Republicans appear to be listening to the lobbyists of K Street rather than the voters on Main Street.

Witness the first weekly Republican address of the new year. In it, Republicans touted two small-ball Obama-care fixes. The first was the Hire More Heroes Act, which the House passed last week. To quote the address, that act “exempts veterans already enrolled in health care plans through the Department of Defense or the VA from being counted toward the employee limit under the health care law.” It had already passed the House last March by a vote of 406-1. Picking it as a lead-off item for the new Congress was akin to taking a vote in favor of puppies or baseball.

Worse, the address also declared that the House would act to modify Obamacare’s definition of a full-time workweek, which it proceeded to do later last week. This is an example of lawmaking that is worse than doing nothing, for it will help give Obamacare—which the Democrats passed without a single Republican vote—a layer of bipartisan gloss. If President Obama were actually executing it as written, Obamacare would require all businesses with 50 or more full-time employees to provide them with Obamacare-compliant health insurance. Obamacare defines full-time employees as those who work at least 30 hours a week; House Republicans voted to change that to 40 hours.

But why would Republicans want to “fix” the law in this way? The focus of Obamacare’s opponents should be on repealing and replacing the overhaul, not on repairing it—and everything they do should be with an eye toward advancing that larger goal. In the short term, therefore, they can look to pull pieces out of Obamacare—particularly pieces whose absence would simultaneously provide relief for Americans and undermine Obamacare. A fine example is the individual mandate: Americans hate it, and Obamacare relies upon it. Another good play is to highlight especially egregious sections that haven’t gotten much popular attention, such as the effective ban on building or expanding doctor-owned hospitals—a striking example of Obamacare’s rampant cronyism, and one that comes at the expense of a group with whom Republicans would be well-served to align themselves.

It is one thing to take pieces out of Obamacare in a strategic way, however, and quite another to reach inside and start actively tweaking and “fixing” it, a trap that Republicans had essentially avoided to date. If they succeed in changing the definition of full-time work from 30 to 40 hours, Republicans will put their fingerprints on Obama-care, a monstrosity not of their making, taking partial ownership of the president’s unpopular namesake.

It is not even clear that this “fix” would help American workers. At National Review Online, Yuval Levin cites Sherry Glied and Claudia Solis-Roman’s findings that there are almost 10 times as many yearlong employees who work 40 hours as who work between 30 and 34 hours. In other words, there are a lot more employees who could see their hours cut to 39 than are currently seeing their hours cut to 29. The Congressional Budget Office notes the same thing: “Because many more workers work 40 hours per week (or slightly more) than work 30 hours per week (or slightly more), the changes .  .  . could affect many more workers than are affected under current law.” On the other hand, larger companies have historically offered health insurance—although not expensive Obamacare-compliant insurance—to most 40-hour workers, without having the heavy hand of government order them to do so under penalty of law. So it’s hard to say for sure whether this “fix” would make things better or worse for workers. It would, however, make things better—in the short term—for some corporations.

A third early Republican push, unmentioned in the address, is to repeal Obamacare’s medical device tax. Like hundreds of other pieces of the mammoth legislation, the medical device tax is bad policy. But it’s also a part of Obamacare that corporate interests loathe and hence are willing to put substantial amounts of money behind eliminating. So long as the medical device tax remains a part of Obamacare, these corporate interests will be engaged allies in the cause of full repeal. If the medical device tax is excised, a little of the wind will go out of repeal’s sails.

The strong popular gusts of support for repeal can certainly withstand this slight diminishment of their power, but the move would still be counterproductive. It would also be a clear sign as to whom Republicans view as their most important constituents. One newly elected GOP member says that throughout more than a thousand campaign events with everyday citizens—with many of those events focusing on Obamacare—he never once had anyone ask about repealing the medical device tax. Yet Republican leaders, responding to lobbyists, are putting the matter at the top of their to-do list.

The new Congress has barely been sworn in, so there is still plenty of time for Republicans to alter their course for the better. By targeting aspects of Obamacare like the individual mandate and the war on doctor-owned hospitals—and, most important, by uniting behind a winning conservative alternative—they could lay the groundwork for full repeal in early 2017.

© 2015 Weekly Standard LLC. Reprinted with permission.