James C. Capretta: How to Replace Obamacare

In the 2014 midterm elections, opposition to the Affordable Care Act — i.e., Obamacare — was a clear political winner. That’s obvious from the election results themselves but also from polling that consistently finds that far more of the electorate disapproves of the law than approves of it.

It is therefore to be expected that the incoming Congress, fully under the control of the GOP, will vote on a straight repeal bill, probably very early in next session. In the House, such a bill will pass easily. But in the Senate, Democrats will control at least 46 seats in the new Congress, giving them plenty of votes to filibuster most legislation they oppose. Consequently, the most likely scenario is that the repeal legislation will die in the Senate and therefore never get sent to the president for a certain veto.

Perhaps that’s just as well, because repeal without a replacement plan is not the best long-term position for ACA opponents anyway. The ultimate goal should be enactment of a plan that is far better than the ACA, with broader and deeper public support.

The electorate is deeply uneasy about the ACA’s approach to reform, for good reasons. It cedes massive new authority over the health system to the federal government. That will lead, inevitably, to more regulation and a lowering of the quality of American health care. The law is also terribly expensive and a wet blanket on the American economy at a time when middle-class incomes are stagnant.

But that doesn’t mean the public is eager to go back to the pre-ACA status quo, which is what is implied with a bill that repeals the ACA but does not replace it. President Obama got one thing right about American health care in 2009: It needed to be reformed – just not in the way he advocated. The pre-ACA health system left too many Americans with inadequate and insecure insurance, treated individuals unfairly who bought insurance on their own, allowed too many people with preexisting conditions to fall through regulatory cracks, and inflated costs with open-ended federal entitlement programs and tax subsidies.

The ACA’s answer to these problems was to consolidate power over the entire system within the federal government. But that’s exactly why the public is so uneasy about what passed in 2010 (in addition to being unhappy with the process that was used to enact it). The door is open for ACA opponents to present an alternative vision for reform that addresses the real problems in American health care without the big-government baggage of the ACA.