Until now, the GOP strategy on health care has been half-baked repeal, half-baked replace, and relying on whatever the Senate parliamentarian allows them to get across the finish line.
Thus, whatever the final product – whether it’s government-run or free-market health care, whether it heals the market or exacerbates the problems – doesn’t matter to them. The future of one-sixth of our economy is just about passing “something” and whatever the parliamentarian does with it. To quote Rep. Thomas Massie, R-Ky., this issue is being treated like a kidney stone, which just needs to be passed – no questions asked.
No wonder the polling of this bill is now in the toilet.
It’s time to either completely change strategy, policy, and messaging on this issue or abandon it altogether. To that end, Sens. Ted Cruz and Rand Paul have at least honed in on the first solution: fixing the process excuse.
A permanently broken economy, ruined health care, and electoral slaughter all because of the parliamentarian?
It is simply ludicrous to have control of all three branches of government, be ensnared in a major political bind on health care, and have the outcome of this make-or-break fight determined by what passes muster with a parliamentarian. That appears to be the central argument posited by Sens. Paul and Cruz who, according to Politico, are urging their colleagues to set aside process concerns and craft the best policy.
Once they agree upon the best policy, they can’t half-bake the outcome because of potential concerns from a parliamentarian. There is nothing worse than half-baking repeal and having the vices of Obamacare blamed on its repeal because of dumb floor process concerns; Republicans must ensure that every element of their bill passes.
Yet, Politico quotes a number of Republicans who are wetting their pants over strong-arming a parliamentarian. From Sens. Roger Wicker and John Cornyn to Sens. Jeff Flake and John Thune, they are all more concerned about setting bad precedent on budget reconciliation rules rather than getting out of the current health care jam, saving the free market, preserving our entire economy, and forestalling an electoral disaster.
Let’s be clear: The majority party controls the chair, and the person sitting in the chair makes the final determination on Senate rules. The office of parliamentarian wasn’t even created until 1935. Elizabeth McDonough, the current parliamentarian, sits below the elected presiding member (a designee of the vice president or Senate pro temp) on the rostrum, not above him. The parliamentarian merely serves as an advisor to the presiding officer and is not constitutionally or legally in charge of the chamber.
The Congressional Research Service, in a recent report on the office of the parliamentarian, articulated the arrangement as follows: “As a staff official, neither parliamentarian is empowered to make decisions that are binding on the House or Senate. The parliamentarians and their deputies/assistants only offer advice that the presiding Representative or Senator may accept or reject …”
For establishment members to hide and incur the political liability of a destroyed health care system and a political bloodbath simply because a parliamentarian made us a Swiss cheese health care bill is simply indefensible. They need to do what it takes to pass the bill.
We are not talking about some obscure provision in a farm bill; this is life and death for our economy and, frankly, their own political survival. Roughing it a bit on Byrd Rule precedent is the least of their problems. Oh wait — they don’t want to repeal Obamacare, so naturally behind Elizabeth McDonough’s skirt is a great place to hide.
The need for a new repeal and reform bill
Once Republicans choose to overrule the parliamentarian to enact full repeal of at least the core elements of Obamacare, they must go all the way on reform to lower costs. Sen. Ted Cruz, R-Texas, is correct in asserting that tort reform, breaking down state barriers, and FDA reforms should all be part of the discussion. We have proposed a number of other insurance and health care supply-side reforms as well that should be addressed in the final bill.
Ideally, Republicans would have immediately enacted full repeal only in January and used the subsequent transition period to enact these additional reforms. But now that Republicans have gotten themselves into a messaging jam and must do it together; they must put their best plan forward.
All these reforms will reduce costs, spawn innovation and competition and, therefore, diminish the need for subsidization. This will all have the effect of cutting the deficit and should be included in budget reconciliation. If Democrats were able to score their plan — which massively increased the deficit — as a budget savings in order to pass muster with reconciliation rules, there’s no reason why free-market, supply-side measures, which will actually cut costs, cannot be included.
At present, Republicans have ensnared themselves in a no-win debacle. By ignoring the focus on actual repeal and competing with Democrats on their messaging of subsidization, Republicans are on permanent defense as to how much government-run health care we will have rather than healing the market itself and decreasing costs.
They passed half-assed repeal in the House by leaving most of the price-hiking, market-distorting elements of Obamacare – and then half-bake replaced by throwing pennies at high-risk pools that are not even modeled properly by statute and are outsourced to the whims of HHS bureaucrats.
Instead, Republicans need to fully repeal the regulations and subsidies for those beyond the Medicaid income level — they are leaving Medicaid expansion in place anyway. Then they should dump $300-400 billion into carefully crafted high-risk pools, writing into statute the guidelines of the successful Maine model, which ensured this didn’t become an open-ended, market-distorting subsidy.
Between massive funding of high-risk pools for those who are sick and keeping Medicaid expansion for the poor, there should be no excuse for not focusing solely on full repeal of the subsidies and regulations that have destroyed the market for everyone else. In addition to the other market reforms, Republicans will be able to craft a new narrative and evacuate from this AHCA dumpster fire, which is polling worse than Obamacare.
The question: Do Republicans really want to govern or is their definition of governing doing what Democrats want, albeit hiding behind the skirt of a parliamentarian?
Daniel Horowitz is a senior editor of Conservative Review. Follow him on Twitter @RMConservative.