Republicans should attack on health care

OPINION:

Why haven’t voters been more concerned about the government shutdown, lapse or whatever? 

Part of the answer is, of course, that 80% of government functions keep sailing right along, more or less on autopilot. Part of it is that for most people, interaction with the federal government is usually an unhappy circumstance, so anything that makes interaction easier to avoid is a good thing.

Some of the lack of interest, however, likely stems from the underlying cause of the shutdown. Democratic insistence on extending the enhanced tax credits for Affordable Care Act premiums is not a powerful political lever. In short, the Democrats may have overestimated the political power of those tax credits. Thought about from a different perspective, voters may have finally figured out that Obamacare has led to more costs and less health care, and a sizable number are therefore not particularly in favor of feeding the beast yet again.

The sticking point between the parties and the ostensible reason for the shutdown is that Republicans rightly believe the subsidies for premiums associated with Obamacare should return to their levels before the Inflation Reduction Act and before the American Rescue Plan — you know, back when the subsidies were only excessively generous rather than obscenely generous.

For the moment, at least, voters don’t seem to care much about preserving the subsidies for premiums. They shouldn’t. The terrible truth is that the subsidies essentially go directly into the pockets of insurance company executives. Our friends at the Paragon Health Institute have noted: “In 2024, 87 percent of the revenue made by insurers selling ACA exchange plans in the 31 states that utilize the federal exchange, healthcare.gov, came from federal taxpayers.” From that perspective, Obamacare appears to be the bagman delivering taxpayer cash almost directly to insurers.

The good news is that insurance executives are willing to share. Indeed, they have given $9 billion to AARP to help sell Medicare Advantage plans to unsuspecting seniors.

For the Democrats, the political calculation on this issue is straightforward. Republicans have never won a vote on Obamacare and have trouble talking about the subject clearly, strongly and without hesitation. Congressional Democrats are counting on that discomfort to ultimately win this particular tug-of-war. That might be a good strategy; it might not.

So far, congressional Republicans have been remarkably disciplined and resisted opportunities to fold. The premium tax credits must go. In contrast, Democrats have had trouble staying on their routine health care message that, in the absence of increasing federal involvement in health care, greedy insurers (yes, the same ones who are partners in crime with the Democrats) will make sure that everyone with a preexisting condition will die, pretty nearly immediately.

Eventually, though, people will see through the defects in Obamacare and become tired of sending money to insurers without achieving better health outcomes. To illustrate the point about the program’s defective architecture, the Paragon Health Institute recently noted that the subsidies set to expire are responsible for only about 3% of total 2026 premiums. The real reasons for the increased premiums are rising health care costs and the indifference to those costs on the part of the architects and custodians of Obamacare.

Republicans should not fold on the subsidies. More importantly, they should take this opportunity to revisit many of the fundamentals of Obamacare. At the very least, they should revisit the requirements regarding what plans should cover. It’s a big country. Things work better when people can buy what they need without too much “help” from the government.

A few simple thoughts should inform other necessary changes. Insurers are not your friends. They are the profiteers in the current system. People should be able to construct whatever kind of associations work best to minimize their risk. The federal government destroys and degrades most of what it touches; health care is no exception. If you have to bribe (that’s what a subsidy is) people to buy something, it is probably not a good product.

Before they can make those points to the public and before they can fix the problems, Republicans have to get over their fear of mixing it up with the Democrats on health care and go on the offensive.

• Michael McKenna is a contributing editor at The Washington Times.