When I first arrived in Washington four years ago, I firmly believed that Republicans weren’t just right on health care, but that we won the debate on health care.
Senate Democrats passed the Affordable Care Act, or Obamacare, in March 2010, and in the following November, voters handed Republicans the majority in the House of Representatives.
In 2014, Republicans took back the Senate, and in 2016, we retained majorities in both chambers and won the presidency by focusing on health care policy.
Republicans failed to replace Obamacare when we controlled all three branches of the federal government, so next Tuesday, March 23, marks 11 years since Obamacare’s passage.
Despite our failure, Republicans remain right on health care. But we must learn our blunders over the past decade so that when we are granted an opportunity to govern again, we don’t repeat those mistakes.
The first important lesson is that while congressional seats can be captured with fiery rhetoric, they can only be retained with legislative success. We learned that the hard way when we failed to deliver on our mandate to fix health care in 2017.
Adding insult to injury, we have largely ceded the debate over health care to Democrats, and—surprise, surprise—Democrats have a majority in both chambers.
The Republican Party must be the party of health care. Over the next two years, conservatives can’t shy away from an issue that American voters’ consistently rate as one of their top priorities.
We must coalesce around a set of clearly defined and articulatable policies, we must develop a plan to make those policies law, and we must convince the public that those policies deserve to be law. Until and unless conservatives do this, our nation will continue its quickening descent toward full-scale socialized medicine.
>>> Interested in learning more about the right way to reform health care? Read this letter from the Health Policy Consensus Group.
The first step is to understand how Democrats were successful in passing Obamacare in 2010 but Republicans were unable to fix our health care system in 2017. Our mistakes and their successes can be boiled down to three areas: preparation, process, and posture.
Poor Preparation. Republicans spent years railing against Obamacare, which was easy, because Obamacare is flawed and for years was very unpopular. While this general opposition superficially bound us together, real policy divisions within our ranks were ignored.
Democrats, too, faced similar challenges leading up to the failure of Clintoncare in the 1990s. But when Clintoncare failed, Democrats spent the next 15 years building consensus and refining and developing the political tools needed to enact Obamacare.
Republicans should have learned from our friends across the aisle on how to build intraparty consensus. Instead, our response in 2017 was unfortunately very different. We essentially failed to spend the amount of time needed to build a policy consensus around legislative text that could be passed into law.
Maybe this was partially due to the fact that many Republicans didn’t really think Donald Trump would win the election in 2016. Whatever the reasons truly were, when it came time to legislate, there was no consensus—neither among Republicans in Congress nor the wider conservative universe.
Now—with Joe Biden in the White House, Chuck Schumer controlling the Senate, and Nancy Pelosi running the House—Republicans have no chance of passing meaningful health care reform any time soon. The upside is that this period won’t last forever, and in the meantime, Republicans can iron out the nitty gritty, so when opportunity arises, we have a specific plan to improve our health care system.
The Republican Study Committee, which I chair, recognizes the importance and urgency of this mission, and has done yeoman’s work to build a health care policy playbook that returns health care decision-making to communities and families.
Without this, we will never be able to have true protections for people with preexisting conditions and a firm basis for providing personalized, affordable care to the American people.
But we can’t stop at white papers. We must turn them into actionable legislation and win the backing of a governing majority inside of Congress, and a robust coalition outside of Congress. That means we must do more than simply run against a public option or “Medicare for All.”
Over the next four years, we must turn the idea of a personalized, community-centered health care system—where patients and families are priorities, and health care freedom is sacred—into a legislative force. Building that consensus will take work. The Republican Study Committee stands ready to support this task.
Poor Process. Republicans not only failed to present a unified and popular legislative package, they also failed to produce a plan to actually usher health care legislation through Congress.
Crucially, Republicans were unprepared to legislate within the confines of the reconciliation process, a procedural tool used to pass bills through the Senate with a simple majority. The process is complex and convoluted, but congressional Republicans should have accounted for that well in advance of 2017, and we should account for it now.
Republicans had a slim Senate majority in 2017, and that will likely be the case the next time we have control of the White House and both chambers of Congress.
So, we should assume we’ll have to use the reconciliation process to reform health care—like Democrats did to enact the Affordable Care Act.
Any bill passed entirely through the reconciliation process may need to start in the Senate. In 2017, we allowed the House to draft the Obamacare repeal without first guaranteeing it would pass muster with the Senate parliamentarian, which may have been a mistake.
Additionally, all provisions in a reconciliation bill must be directly related to the budget, so Republicans should tailor all health care policies with that precondition in mind.
The second mistake Republicans made in 2017 was relying on a closed-door process, where final proposals were cooked up in back rooms and clouded in secrecy.
It wasn’t just the American public that had virtually no clue what would ultimately be in the package, nearly every rank-and-file member of Congress was left in the dark too. Members found out what was in the bills the same time the public (except K Street lobbyists) did.
So, when it came time to ultimately pass the American Health Care Act—the Republican plan to repeal and replace Obamacare—members were ill prepared to defend the policies contained in the bill or were—at least initially—unsure whether they were worth defending at all.
Consequently, Republican members were defenseless when congressional Democrats and the liberal media began attacking the legislation and its supposed disastrous effects, particularly on people with preexisting conditions.
Town halls turned moblike and felt more like a facing a firing squad than a civil discussion with constituents. Many Republican members resorted to individual or group tutorials with conservative health care experts just to prepare themselves for town halls.
Things only got worse when we were blindsided with inaccurate estimates of coverage losses from the Congressional Budget Office (which were corrected years later).
To ensure a successful product, a better process must start now. Senate and House Republicans need to develop a unified plan to pass health care legislation, and they need to be conversant in the substance of the legislation before it comes time to vote. That brings me to my final point.
Our Posture. The defensive posture Republicans adopted on health care resulted in a stale, unconvincing vision.
Part of the reason a transparent, public conversation about the Republican Party’s health care agenda is important is because it will give Republican members time to better understand and articulate a clear vision for what conservative health care policy looks like.
In 2017, for the vast majority of Republican members, critical parts of Obamacare like “community rating,” “medical loss ratio,” “high-risk pools,” and “minimum actuarial value requirements” may as well have been quantum physics. How can members be expected to articulate the downsides of policy they don’t understand?
More importantly, how can we expect the public to oppose something if their representatives can’t explain why it’s worth opposing?
In 2016, Republicans adopted the poorly thought out slogan, “Repeal Obamacare!” It showed only what we were against and not what we were for, and made it seem like Republican members had little understanding of health care policy.
Democrats capitalized on our mistake by talking as if Republicans planned to gut America’s health care system entirely and leave everyone without health insurance. “Repeal” soon morphed into “repeal and replace,” but by that point the damage was done.
While Democrats continue to make the conversation simply about providing insurance “coverage,” our task force believes the best health care policies should instead be aimed at improving the actual provision of health “care.”
In the past, we allowed the difficulty of this conversation to keep us from articulating a clear, caring path forward that protects individuals with preexisting conditions while ensuring that no American falls through the cracks of a strong, resilient safety net.
Republicans need to coalesce around an effective message, but we also need effective messengers. At the Republican Study Committee, our health care task force is chaired by Rep. Chip Roy of Texas, a cancer survivor. Roy understands the pain and fear that millions of Americans live with every day, caused by an uncertain, broken health care system.
Roy is well-spoken and knowledgeable, but we’re going to need a deep bench of Republican health care leaders. Fortunately, last fall, Americans elected one of the youngest, most diverse classes of Republican lawmakers in history. We must educate and empower these members to help articulate our vision.
We need to bolster and equip future health care leaders in Congress like Rep. Victoria Spartz of Indiana, who brings a firsthand understanding of the perils of socialized medicine from her childhood in Ukraine. She also has firsthand experience fighting for conservative principles on health care at the state level.
President Barack Obama launched his effort to overhaul America’s health care system on March 5, 2009. But he didn’t do it alone, or just with his Cabinet and like-minded members of Congress. He made the announcement during a forum that included 150 representatives from labor unions, think tanks, consumer organizations, and other groups. Here, too, we should take a page from Democrats’ playbook.
Republicans should be working closely with grassroots coalitions and leaders across the conservative universe to understand and craft health care policy. The Republican Study Committee is perfectly situated to accomplish that. We must connect the dots between these coalitions and conservatives in the House and Senate.
The Future of Health Care Is Republican. The Republican Study Committee’s health care agenda is ambitious. The 117th Congress offers an opportunity to refresh our approach. In my position as chairman, I have a duty to unify Republicans behind a vision the American public understands.
No matter what solutions we offer, Democrats and their leftist cohorts in the mainstream media will paint us as trying to take away Americans’ health care. While this is far from the truth, they will be successful if we continue to retreat. The time has come for Republicans to go beyond mere slogans.
We agree that expanding health savings accounts offers flexibility to Americans. We believe in a strong safety net, with guaranteed coverage pools for Americans facing the most burdensome health crises. We understand that a strong and sustainable Medicaid system will help ensure that our vulnerable brothers and sisters do not get left behind. We believe that Americans prioritize health care because they want the people they love to have access to the care they need.
These are commonsense principles and solutions Americans can get behind.
Over the next four years, we must do the grueling legislative and coalition-building work, and we must be prepared to revisit and reanalyze existing policy proposals. Conversations on congressional procedure and consensus can’t be left only to committee and congressional leadership.
If we do this well, we can show voters the Republican Party is the party of health care.
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