Republicans Need a Real Health Care Plan

Health care was a top issue in the 2018 midterm beatdown of the GOPGetty Images

The GOP may never run on a health care agenda, but it needs a health care plan to avoid electoral whippings

Republicans got pummeled at the ballot box last month on health care. Yes, it was an anti-Trump wave, centered in districts dominated by college-educated whites who deeply dislike the President. But, the often comparatively moderate candidates who dominated Democratic gains explicitly ran on health care as part of agenda designed to appeal to voters rather than inflame them – and not single-payer or Medicare-for-all either, but more modest undertakings such as protecting the Affordable Care Act/Obamacare.

Republicans may be prone to pay little heed to such a trend because aside from opposing Obamacare, health care is a leading campaign issue for Republicans about as often Democrats run on regulatory relief for small businesses. Yet, health care was not only the leading issue for Democrats, accounting for ½ of their advertising, it led exit polls as the top issue of voters at 41% (immigration was a distant second at 23%). Those citing health care voted 75/23 Democratic.

That’s, um, decisive.

But, health care didn’t just win at the Congressional level. Citizen initiatives to approve Medicaid in expansion in the face of reluctant legislatures all won in deep red states: Utah, Idaho, and Nebraska. Meanwhile, Kansas and Maine elected Governors who will not act as barriers to previously approved expansion in those states like their Republican predecessors. The map of state Medicaid expansion shows only 13 states that have not expanded Medicaid (presuming the Kansas legislature again sends Medicaid expansion to the Governor), which excepting current GOP legislative control in Florida and Wisconsin are deep red states.

State Medicaid expansion continued to grow based on election resultsKaiser Family Foundation

Yes, again, it was a Democratic year, but health care was a winning issue in 2018.

The skeptic might say, “so what, why should it be again?”

Do you care about controlling government spending? Then health care will be an issue again.

The steady growth of health care spending as both of a percentage of GDP and government expenditures (including because of the rising number of Baby Boomers in retirement) is inexorable.

Moreover, the continued rise of health care spending coincides with an emerging understanding that costs are rising for the public and private sector not primarily because of waste, fraud, and abuse or the high cost of government regulation (though those are issues too), but because of the price of health care Americans receive.

Fun fact: what’s the one thing neither Obamacare nor Republican attempts to Repeal and Replace addressed? Health care prices. Yes, the law and its hoped-for GOP alternative were almost entirely focused on playing on the margins of regulating health care coverage, not the cost of care that is a dominant percentage of the premium dollar.

The (rising) cost of health care is the single largest driver of health care coverage costsAmerica's Health Insurance Plans (AHIP)

​I say “hoped-for GOP alternative” generously, because Repeal and Replace was a walking disaster. Don’t just take my word for it, take also that of conservative health care wonk Chris Jacobs. While Jacobs and I are not likely to agree on exact policy solutions, we both agree GOP attempts to create a substitute for Obamacare were a hopeless combination of a grab bag of GOP policy ideas paired with support for access to coverage for people in the individual market with pre-existing conditions.

Part of the reason Repeal and Replace was such a mess is far too many conservative elected officials, staffers, think-tank wonks, and other opinion leaders don’t understand health care policy or the health care system all that well.

They better start. Aside from the lurking issue of government spending on health care, the private sector is increasingly animated about their health care costs as well. Note in the middle of the big announcement at the start of this year about Amazon, Berkshire Hathaway, and JP Morgan Chase teaming up on a health care venture was this key statement:

"The ballooning costs of healthcare act as a hungry tapeworm on the American economy," Berkshire CEO Warren Buffett said in a statement. "Our group does not come to this problem with answers. But we also do not accept it as inevitable. Rather, we share the belief that putting our collective resources behind the country's best talent can, in time, check the rise in health costs while concurrently enhancing patient satisfaction and outcomes."

Health care is a top tier issue for both the public and private sector. Future health care agendas are essential for good governance moving forward.

So what’s the conservative solution?

You’re not going to dramatically reduce eligibility for Medicare or Medicaid. A Republican President, Senate, and House, couldn’t even make relatively incremental changes to an already comparatively incremental law in Obamacare without major political fallout. If you think simply cutting Medicare or Medicaid are political winners, I invite you to enjoy your extended time in the Congressional minority.

Yes, Medicare and Medicaid will definitely require reform, even as addressing the issue of Obamacare’s problematic impact on the affordability of individual market coverage for middle class consumers is still necessary as well. Yet, a clear lesson of recent electoral politics is Republicans don’t have the combination of a winning message and a winning policy solution for health care. Not even close.

And that needs to change.

No. 1-11

We call insurance healthcare, which its not. Insurance is supposed to protect us from catastrophe. People are so used to employer paying coverage and paying little or nothing out of pocket and that is the expectation. In the "old days" we had the plans where insurance paid 80% and you paid 20% until you reached a deductable. Now you pay your 20 dollar copay. It seems to me that for most, its the cost of drugs that is the problem. How do we make that more affordable?


The only candidate to build a campaign around Healthcare reform was the first candidate to burn out and get kicked out of the 2016 campaign. Two years later, Bobby Jindal and his wonderful ideas are absolutely nowhere to be found. Republicans spoke, they don't want a healthcare plan and the're just fine getting pounded at the ballot box for it.


IMO: This needs to be tackled with regulation. The example I use is requiring all providers to publish price lists for common services (anything that's predictable) and for those prices to be the same for all customers, regardless of who is paying.

I cannot think of any other area where it's acceptable to say, we don't know what it will cost, but don't worry we will bill someone, something, on your behalf. Oh, you might have to pay some yourself, depending on what that other someone says later.

Drugs, patents, and monopolies, are also a unusual problem in health care. Drugs are super expensive to research and take to market. Therefore there needs to be a ROI for them. However, what we have seen recently with the 1000% price hikes under monopoly protections is morally wrong. This doesn't have an easy answer. But I think it's reasonable to limit profits while under a government provided monopoly status. Give the corporations the option to opt out by giving up their monopoly protection (patent). Ironing out the details here will be a mess.


The healthcare of the nation's citizens is much too important to be entrusted to a bloated, inefficient US government. The healthcare system worked much when the citizen determined their needs, their risks and what they were willing to pay for good healthcare and the cost was a lot less than since the government got involved. The private sector insurance and healthcare providers are the experts; not the politicians or civil service employees. A big part of the cost of healthcare is paperwork! A physician in private practice (if you can find one) must have at least one person devoted to the paperwork required by government regulations. Non-health insurance, such as auto, homeowner, renter, etc. works quite well because of competition and a lack of government involvement.


You mean like privatizing Medicare and Medicaid and restoring the free market to the health care sector by getting rid of third-party payment? That'd be the only "plan" that can actually work. Pity that's not how "plans" are defined anymore. Which is why Republicans can never compete with Democrats on this issue.