WASHINGTON — Conservative politicians best not repeat their mistakes from a few years ago on healthcare reform if they want to win Americans over to their side on the issue, speakers said at an online event sponsored by the Heritage Foundation, a right-leaning think tank here.
“I came to Congress in 2017 … and I remember thinking that if Donald Trump wins the presidency as he did, and Republicans have the majority in the House, in the Senate, we’re going to have a heck of an opportunity to do a lot of things that Republicans have promised to do for a long time,” including reforming healthcare, said Rep. Jim Banks (R-Ind.), chairman of the Republican Study Committee, at Monday’s event. “I couldn’t have been any more wrong … We are doomed to repeat the same mistakes if we don’t look back at 2017.”
Three Major Mistakes
The Republicans made three mistakes during that time, Banks said. First, “we had a bad process at work, with Republican leaders who weren’t on the same page with the bulk of the Republican conference,” he said. “There wasn’t consensus among a majority of the rank-and-file members of the Republican Party.” Secondly, there was poor preparation for a vote on healthcare reform. “Leading up to that point there clearly wasn’t a game plan. And thirdly, we really had the wrong posture — I mean, it was all about being against Obamacare, but Republicans really fell flat on their face in not providing a posture about what we were for.”
The Republicans’ unsuccessful effort at reform, a bill known first as the American Health Care Act and later as the Health Care Freedom Act, “was a wounded bill from the outset,” Banks said. In addition, there was “the media narrative of pre-existing conditions, and Republicans not being prepared to address it and answer questions about how we were taking care of those with pre-existing conditions.”
While Democrats like Rep. Alexandria Ocasio-Cortez (D-N.Y.) and independent senator Bernie Sanders of Vermont have been pushing the Democratic Party farther to the left on the healthcare issue — toward a “Medicare for All” single-payer plan — “Republicans have consistently failed to provide our own positive image of what we stand for, and that’s what the Republican Study Committee aims to fix,” he said.
“Our job is to write the plan, and then develop the right structure, the tactics, the strategy that it will take to pass that plan when we get the majority back and when a Republican wins the White House,” Banks concluded. “But if we don’t prepare for that moment like Republicans failed to prepare leading up to the 2016 election, then we’re going to repeat the same mistake over again.”
Changing the Narrative
Dan Ziegler, the Republican Study Committee’s executive director, agreed. “Unfortunately, I think in many ways we’ve accepted the other side’s framing on these issues,” he said. “We’ve gotten ourselves into a defensive posture and there’s a narrative that Republicans can’t win on healthcare — I reject that. I think we have a moral responsibility to make this a top issue and bring a compelling case to the American people … We have to push back that we have an alternative, that we have a vision, that we care about people, and that we want to demonstrate that.”
“What’s wrong with conservatives, is the way they talk about healthcare,” said John Goodman, PhD, president of the Goodman Institute for Public Policy Research, a right-leaning think tank. “And if we don’t talk about healthcare in a way that relates to problems of real people, we’re just not going to be successful.”
Regarding the Affordable Care Act (ACA), which Goodman and other speakers referred to as Obamacare, “what are the two biggest problems that everybody in Obamacare has? They are facing sky-high deductibles — which for many don’t really count as real insurance at all — and very narrow networks, which exclude the best doctors and the best hospitals,” he said. “The Democrats talk about taking care of people’s pre-existing conditions, but they’re not helping you if you’re in a network where you can’t see the best doctors and the best hospitals.”
Doug Badger, visiting fellow at Heritage, pointed out that Democrats have tacitly admitted that the ACA is an unattractive product by announcing they want to make fixes to it. “Unfortunately, the solution is not to make healthcare more affordable, or to bring the competition that would give families choices among plans; the idea is just to put more government money into it. So we’re not going to reduce the premiums, we’re going to increase the subsidies. … So they have the right diagnosis — they have the wrong solution.”
Badger outlined some of the conservative healthcare ideas, many of which are included in the foundation’s Health Care Choices proposal. “That means choice of health plans — that includes plans that will cover people with pre-existing conditions, but there will be other products and arrangements out there as well,” he said.
Other features of the proposal include access to “direct contracting” plans, in which patients pay a monthly fee for comprehensive primary care; “health sharing” arrangements (also known as health sharing ministries) that involve members writing checks each month to cover other members’ healthcare costs; and expansion of health savings accounts (HSAs) that allow employees to use tax-free money to cover health insurance premiums and other healthcare expenses.
“It’s allowing employers — instead of providing a health plan — to provide their workers with accounts that they could use to buy coverage that they own and can take with them from job to job,” Badger continued. “It’s about a market-based place with competition, price transparency, so that consumers know what the prices are going to be of the care before they access it and so the providers have to compete on price.”
Dean Clancy, senior health policy fellow at Americans for Prosperity, a right-leaning think tank, added that conservatives also favored removing barriers to the practice of medicine, including allowing nurses to practice at the top of their license “so they don’t have to be going through hoops to please a physician; they should just be able to deliver healthcare, including in rural areas. We should allow direct primary care arrangements and telehealth across state lines, and we should repeal ‘certificate of need’ laws that basically say that a hospital can’t add a bed or a wing or a new MRI machine unless some government board says it’s okay. That’s crazy, and it’s un-American.”
On the politics side, Goodman lamented the fact that the Republicans didn’t hold a hearing on the ACA’s flaws. “They never once held a hearing on the high deductibles or the narrow networks …We should have held hearings, we should have been very clear about what we don’t like, and what we want to change. Voters are going to respond better to that, than [to] rhetoric.”
“Conservatives need to be clear — they need to be addressing people, not speaking in jargon, and understand what people want, which is affordable healthcare,” Badger said. “They want to be able to see the doctors of their choice, and to have the wherewithal to afford the treatments that those doctors afford, and low-income people, I believe, want and deserve access to the best coverage, not being relegated to the sorts of coverage that they get through Medicaid HMOs … We need to have the ability to talk to people in the language that they understand and to let them know why the policy initiatives that conservatives want align much more closely with what the people themselves want than what is being foisted on them by the left.”
Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow