By leaving a dysfunctional regulatory apparatus intact, driving up premiums, and increasing the number of people entitled to subsidies while reducing the number of people covered, the AHCA’s insurance reforms managed to alienate both liberals and conservatives. Only 17 percent of Americans approved of the proposal. A reasonable case was made that even though the bill was imperfect, it contained many worthy reforms to Medicaid and its insurance provisions could be improved in the Senate. A pivotal group of House Republicans rejected it anyway, despite warnings from Speaker Ryan that this would leave Obamacare as the law of the land.
The amendments proposed over the past month have done much to vindicate the holdouts. Every change advanced has made the proposal less attractive to major beneficiary groups, its sprawling subsidies have become more entrenched, and the bill has lost more supporters than it has gained. The House GOP remains far from agreement, despite a majority of 45. In the Senate, reconciliation procedures would empower Democrats to force Republicans to vote on dozens of politically painful amendments in full view of TV cameras. With a Republican majority of only two, it is hard to predict the shape in which a bill would eventually emerge from the upper chamber.
House Republicans are right to ask why they should vote for a bad bill that won’t make it into law anyway. Instead of straining with reconciliation to patch the fissures in the insurance market, the GOP should employ the regulatory powers of the Department of Health and Human Services to fix it. By repealing an October 2016 regulation that was used to prevent the sale of actuarially priced “short-term” insurance, Secretary Tom Price could reestablish a market in which health insurance is competitively priced in proportion to most individuals’ health-care needs. This would relieve the exchanges and their subsidies of much of the burden placed on them, repurposing them as a targeted safety net for the chronically ill.