Prepare Now to Repeal ObamaCare Later - The Wall Street Journal

After Sen.

John McCain’s

thumbs-down vote doomed Republican efforts to repeal ObamaCare in 2017, the party’s leadership largely abandoned the effort and shifted to other topics. Congress zeroed out the individual-mandate penalty as part of its tax-cut legislation; Republican attorneys general tried unsuccessfully to use that action to convince the courts to repeal the law; President Trump promised to replace ObamaCare with a better plan. Sens.

Lindsey Graham

and

Bill Cassidy

offered their own plan, but Republican leaders never brought it to the floor and seemed happier to forget the entire healthcare topic.

Republicans need to be better prepared the next time they control both chambers of Congress and the White House. President Biden’s sinking poll numbers and Democratic infighting may give them that opportunity in three years. To avoid another failure at repealing ObamaCare, Republicans need to convince voters that they have a viable replacement.

Liberals attack conservatives by forcing them to defend the worst aspects of the status quo, even though today’s dysfunctional healthcare system is a far cry from the patient-centered system conservatives champion. Republicans should move beyond simply opposing bad liberal healthcare reforms and offer their own vision of reform. By putting forward a series of incremental conservative healthcare reforms now, GOP lawmakers would increase their chances of success and provide a backup plan if they fall short again.

Offering stand-alone amendments to the next Democratic social-spending behemoth would force swing-district Democrats to choose between representing their constituents by supporting popular proposals and following their party’s radical leadership. Reforms can increase voters’ appetite for a more patient-centered healthcare system, in the same way that limited scholarship programs and capped charter school enrollment led to comprehensive school-choice legislation. Here are some ideas:

• Permanently expand access to telehealth services. During the pandemic emergency, Medicare waived originating site and geographic restrictions. These regulations could be abolished permanently.

• Allow wider use of health savings accounts. These accounts allow patients to pay out-of-pocket expenses with pretax dollars, giving them more control. Legislation could increase contribution limits, decouple the accounts from high-deductible insurance plans, codify coverage of additional preventive care for chronic conditions and classify direct primary care, in which the patient pays a flat monthly fee to a doctor instead of a bill for specific services, as a qualified expense. Medicaid and Medicare should also be authorized to reimburse and contract with direct primary care providers.

• Repeal rules that limit health-insurance options. Allow Americans to purchase any health plan approved by their state insurance commissioner, including catastrophic coverage. Repeal the ACA’s employer insurance mandate, allowing more flexibility to help employees afford healthcare services. Codify Trump administration rules that eased restrictions on health reimbursement arrangements, association health plans and short-term, limited-duration health plans.

• Codify the authority of states to implement work requirements and modest premium and cost-sharing requirements in Medicaid. This would entail repealing recent Biden administration actions and court rulings and giving states more flexibility to move their Medicaid programs toward premium-support solutions and direct subsidies and away from all-or-nothing, one-size-fits-all coverage.

At the state level, lawmakers should offer similar healthcare reforms. They should codify price transparency requirements, remove barriers to the adoption of telehealth, allow small employers to pool resources to offer their employees group health coverage through association health plans, remove state restrictions on short-term, limited-duration insurance, permit alternative health benefits for membership-based organizations like Farm Bureau health plans, expand the ability of patients and doctors to use the direct primary care model, discourage frivolous lawsuits and unnecessary defensive medicine, enforce antitrust laws against consolidating healthcare systems and plans, and enhance competition by repealing certificate of need requirements, allowing providers to practice up to the scope of their training, and allowing interstate medical licensing.

None of these reforms alone go far enough, and that is the point. Democrats have steadily grown the government’s role in healthcare through decades of incremental steps, culminating in ObamaCare. Republicans should use the same strategy to reverse course and empower patients over bureaucrats. Twelve years after ObamaCare was enacted, repealing and replacing it remains the goal for Republicans. Doing so will seem less risky to voters if preceded by successful steps in that direction.

Mr. Jindal served as an assistant secretary of health and human services (2001-03), a U.S. representative (2006-08) and governor of Louisiana (2008-16).

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