At last in control of both houses of Congress and the presidency, Republicans wisely put a priority on additional health care reform.
Though hailed at the time as a triumph for liberals, Obamacare ultimately divided Democrats, some of whom had warned from the outset it would prove too cumbersome and unreliable for many Americans to navigate or support. But the GOP approach to fulfilling its promise of "repealing andreplacing" Obamacare has gotten off to a shaky start. Voters' justified frustrations and expectations should focus Republicans' minds around taking the right way forward before it's too late.
From the standpoint of politics as well as policy, the smart move is to make a few significant alterations to the current bill. As written, it dissatisfies in two directions -- bringing too little reform to Obamacare on the one hand, but shifting too many people out of coverage, with not enough of an alternative, on the other.
Americans are responding negatively. New polls indicate that, although the level of opposition to the bill is about level with Obamacare's unfavorables when it passed, only about a third of respondents like the new bill, while closer to 40 percent backed Obamacare as it became law.
That is a potentially huge problem for Republicans -- who owe President Trump's election to a small constituency of President Obama's voters willing to take a chance and flip their blue states red. What these and other voters want is clear: simplicity and catastrophic coverage.
Republicans should deliver before moving on to work through other potentially important reforms. After all, the most dogged criticisms of Obamacare -- outside the Beltway -- focus around the Byzantine process of choosing and maintaining affordable coverage that takes the risk of medical bankruptcy off the table. Bernie Sanders Democrats complain that a direct government entitlement would be an improvement, harking back to an infamous sign at a Tea Party protest urging government hands off Medicare.
Although much of Obamacare's limited success ended up coming through the expansion of Medicaid, too many Americans are stuck struggling for workable coverage that satisfies the individual mandate. This is an undue burden. The fact is, a well-tailored entitlement benefit is better for
Americans -- and better for America -- than a bureaucratic thicket working families must hack though at least yearly, uncertain of what new rules, restrictions and cost increases await.
To make good on this reality, some Republicans will have to make adjustments to their own political expectations. Beyond considering a straightforward new entitlement up front, they will have to recognize that pre-existing conditions also fall within the ambit of Americans' expectations around simple catastrophic coverage.
House Speaker Paul Ryan and others are not connecting with the public, including many in their own party, by touting instead the current bill's salutary impact on the size of the federal debt. Instead, they need to make the plain and credible claim that Americans' sharpest health care fears are going to be allayed.
That done -- and not before -- lawmakers can turn to the bells and whistles of reform, with the GOP's many dedicated and intelligent health care wonks making changes within a framework Americans can finally trust.