(Bloomberg View) — Members of Congress are home on recess this week, where they’re facing — or not, as the case may be — angry constituents. Many are concerned that the health insurance on which their families depend will disappear before Republicans muster even the pretense of an alternative.
It’s a sensible concern. And Republicans could put it to rest. Millions of Americans, including many who voted Republican in November, don’t want to lose their insurance coverage. Governors, including Republicans such as Michigan’s Rick Snyder and Ohio’s John Kasich, don’t want to forfeit the gains that their states have made under the Affordable Care Act’s Medicaid expansion.
Republicans can and should make adjustments to the law. They can buttress state insurance markets and cap tax-free benefits to limit the growth of “Cadillac” health care plans. They can devise incentives for young and healthy people to participate, making the markets less risky overall for insurers. They can restrict consumer options, as President Donald Trump’s administration has recently proposed.
Yet the signs are not encouraging. House Speaker Paul Ryan, for example, is becoming both more bold and less believable in his statements about the Affordable Care Act. “We need to replace it with a true, patient-centered system, one that gives every American access to quality, affordable coverage,” Ryan said last week after another inconclusive meeting of House Republicans.
The vague outline that Ryan released consists mostly of boilerplate, such as health savings accounts, high-risk pools and Medicaid block grants to the states. Equally familiar is the total absence of a funding mechanism (accompanied by a studied refusal to acknowledge that no such mechanism exists). Even this paltry outline, eight years in the making, failed to produce consensus among House Republicans.
If Republicans are unwilling to replace the Affordable Care Act with anything as comprehensive, they should at least be willing to say so. And if their objection to the law, as Ryan said seven and a half years ago, is essentially philosophical — that it has forced millions of Americans into “becoming dependents on the state rather than being dependent upon themselves” — then they should say that, too. They have lately avoided doing so, perhaps because they suspect more Americans support affordable health care than conservative ideology.
For years, Republicans have postponed this conflict between their ideology and the needs of their constituents. Now their reckoning is here.
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