What next for health-care reform? Possible strategies for the GOP

Republicans do not need to return to health-care reform immediately. There are many other issues, from infrastructure to immigration, that would more closely align with the animating issues of the Trump campaign and where important reforms are needed. However, there could be a political risk in not making some attempt at health-care reform. Republicans have had significant electoral victories over the past few cycles in part because of public frustration with the many shortcomings of the Affordable Care Act, and the U.S. medical system is in need of reform. If Republicans do return to health care, they could simply seek an outright repeal of the Affordable Care Act. They could also try to pass a slightly different bill through reconciliation or offer a more comprehensive health-care bill that does not need to go through reconciliation. Or they could use some combination of these strategies. But whatever approach they take, Republicans might be wise to develop an affirmative vision for health-care policy.

Pascal-Emmanuel Gobry has argued that conservatives should do the following policy two-step: “Slash regulations. And then subsidize health care.” There’s a certain logic to this process. It would allow Republicans to focus on health-care efforts that might be more popular (market-oriented reforms) while avoiding parts that might be more divisive (such as cutting Medicaid for the poor and working class). Rather than “repeal and replace,” it could instead be called “reform and retain.” Medical regulations could be reformed (including many of the new regulations in the ACA), but many subsidies for low-income Americans would be retained. Reform and retain might end up repealing many elements of the ACA, but the focus would be on improving the American health-care system — not simply eliminating the ACA. (Of course, the Affordable Care Act has inflicted damage on the health-care system, and any effort at reform would have to confront those injuries.)