Some conservative policy pundits are starting to imagine a detente over Obamacare, in which Republicans recognize the conservative nature of the law and support it in return for tweaks that advance their ideas. Liberals should be open to such a deal.
Even though Democrats passed it, the Affordable Care Act offers a hospitable environment for conservative reform. That’s not just because it incorporates aspects of a proposal from the conservative Heritage Foundation, closely resembles the health- care-reform bill that Mitt Romney signed in Massachusetts, and bears striking similarities to earlier proposals by Republican members of Congress. No, the reason the ACA may be good for conservatives is that it provides a sound chassis for many of their health-policy proposals.
Some of us have been saying so for years; finally, some conservative thinkers are recognizing it too. In a recent op-ed, Paul Howard and Yevgeniy Feyman offer ideas that would “make Obamacare a Trojan horse for conservative health-care reform.” Ramesh Ponnuru, Yuval Levin and Ross Douthat have also proposed reforms consistent with Obamacare’s structure. Well, it’s about time! Despite that the ideas are being offered from the right, liberals should rejoice.
Imagine what could be accomplished if conservatives built a coalition for reasonable changes to the law, instead of wishfully thinking repeal was within reach: Democrats could rest easier about the law’s future, and Republicans could advance their priorities. With the basic structure in place, so much could be achieved with relatively modest change.
Some conservative ideas mesh seamlessly with the ACA’s structure. It would, for example, be easy to change the law so that more catastrophic plans could be offered on exchanges. Similarly, adjustments to the “Cadillac tax” on high-cost insurance plans could help to cap or phase out the employer- sponsored health insurance tax subsidy, a goal that House Budget Chairman Paul Ryan has supported.