When it comes to healthcare, the events of 2017 were probably not what many Republicans hoped for.
This time last year, repeal of the Affordable Care Act seemed imminent. Even up until a few months ago, rolling back the health reform law still seemed pretty likely. But after multiple proposals to repeal the ACA failed to pass, efforts are now at a standstill.
As Republicans look toward 2018, all the hopes for repeal are pinned on the party’s tax bill, which looks close to passing before Christmas. The bill currently includes a provision that would repeal the individual mandate, setting the party up to reshape the U.S. healthcare system in the coming year.
So as the party looks back on the lessons of 2017 and into the new year, here are three healthcare “New Year’s Resolutions” for Republicans.
Pick a party goal
A key takeaway from the past year’s repeal attempts was that, aside from repealing Obamacare, Republicans were not very united around any particular healthcare vision or goal. Arguably, this was one of their biggest challenges.
Some Republicans wanted to see the law completely repealed and the healthcare system return to its pre-2010 status. Others wanted to see some of the ACA’s more stringent regulations rolled back, while still keeping some protections for consumers. Others still wanted to create an entirely different healthcare system.
Ultimately, lacking consensus made it difficult for the party to coalesce around a plan, and the opportunity of repeal alone was not enough to sway constituents or holdout legislators.
Through the tax bill, Republicans are building their platform on repealing the individual mandate. Additional reforms will be needed to stabilize the insurance market if or when that happens, and many Republicans would say that finding the party’s main healthcare goal should be the first step for the party in 2018.
Is the goal of any new legislation to reduce costs? To improve access to care? To reduce regulation in the healthcare industry?
Republican leaders may be more successful in 2018 by picking a key goal, and being clear about how their bills would achieve it.
Set a date for repeal—then move on
If the party successfully repeals the individual mandate without follow up legislation, it’s likely that most insurers will leave the individual market for 2019. Because of this, Republicans should certainly try again to repeal and replace the ACA with something better.
Many voters and legislators alike have pointed out that the party has had ample time to create a competing plan to the ACA. If after eight years and in a fully Republican-controlled government, party leaders are unable to convince their colleagues or the country that they have a better plan, it may be time to focus on improving rather than replacing.
If the party can’t pass a repeal and replace bill by, say, June—a year after their initial American Health Care Act was released—the party should move on, and transition instead to making the current law work better.
They can do this by instituting a replacement policy for the individual mandate, such as the continuous coverage policies found in their 2017 repeal bills. These policies would prohibit insurers from denying insurance to consumers with pre-existing conditions, so long as the consumer had maintained continuous coverage.
Republicans are more in favor of this policy than the individual mandate, because it puts the responsibility on the consumer to obtain insurance, rather than taxing them for failing to do so. By changing this policy, Republicans can say they successfully reformed the ACA to be more conservative, while still leaving the more popular pieces of the law intact.
Letting go of repeal may seem blasphemous to many Republicans, but the reality is that the healthcare system is suffering from years of uncertainty. Payers and providers alike are unable to make the kind of long-term investments in improving the system under the unending threat of repeal.
Changing the narrative to one of compromise and improvement could benefit Republicans, and actually give them some leeway to implement some of the smaller changes they would like to see in the healthcare system.
Focus on improvements outside of repeal
That brings us to the final resolution for Republicans. Even if the party is unable or unwilling to repeal the ACA, Republicans can still improve the healthcare system and make it more competitive and conservative. One way to do this would be through what are called ‘state innovation waivers, which allow individual states to implement healthcare policies outside of the ACA. Currently, these waivers have to meet certain standards. For example, a waiver policy has to cover the same number of people as the ACA would in the state. However, this year, Democrats have shown willingness to give states more flexibility on how these plans are implemented and the standards they have to meet.
If Republicans put their efforts toward compromising with Democrats on state waivers, it would be much easier for conservative states to implement the kind of market-friendly reforms Republicans support, even within the framework of the ACA.
No doubt that 2018 will be another exciting year for healthcare. It will be interesting to see the impact that the Republicans’ tax bill has on the debate.