Does the GOP Really Care About Healthcare?

After the American Healthcare Act (AHCA) fiasco of the past month, put me down for a firm “no.” The GOP had seven years to come up with a viable Obamacare replacement plan. If the AHCA is the best they could do, that is pathetic. Especially because well-thought out conservative plans are out there.

The AHCA was so poorly designed, I have to think it was not a serious attempt to produce a viable—and superior—alternative to Obamacare. No, my cynical side sees the intentions behind the AHCA differently. I believe the AHCA was merely meant as a way for Paul Ryan and leadership to pass their tax reform plan.

It’s no secret that Paul Ryan’s real passion is in the area of tax reform. Being Chairman of the House Ways and Means committee was his dream job. Like a modern-day Cincinnatus, Ryan begrudgingly gave up the Chairmanship to become Speaker of the House.

At the time, Ryan’s Ways and Means Committee was hard at work on tax reform. The fruit of this labor was last summer’s ambitious “A Better Way” blueprint. The plan calls for only three tax brackets and fewer deductions and credit such that the new 1040 would be the size of a postcard.

The “Better Way” plan posed just one problem for the GOP. It’s tax cuts were so ambitious, it cast doubt on the GOP’s pledge to do revenue-neutral tax reform. This is where an Obamacare replacement plan comes into play.

In order to be financially viable, Obamacare needed more tax revenue, so new taxes like the 3.8% net investment income tax were levied. By removing these revenues in an Obamacare-replacement bill, the GOP can lower the revenue baseline, thereby making revenue-neutral tax reform easier.

When I look at the AHCA, I see a piece of legislation that lacks vision. It lacks boldness in either a conservative or moderate direction. I think Ryan and the GOP leadership hoped it gave enough to moderates and conservatives that they'd pass it. But it didn’t. Now the plan for tax reform is all out of whack.

I know I’m proposing a cynical theory, but I can’t help but believe the truth of it. Otherwise, I have to believe that a policy wonk like Ryan actually thought this monstrosity of a healthcare bill was a superior alternative to Obamacare. The AHCA preserved some of Obamacare’s most hated aspects while implementing ideas that were almost a twisted version of those proposed in superior conservative replacement plans.  

So, will the GOP get its act together on healthcare reform? Will we actually get a new and improved bill as Ryan is promising? I doubt it. Signs already seem to indicate Ryan’s pledge to continue work on the AHCA is merely a face-saving tactic.

Mark Meadows, head of the House Freedom Caucus—one of the most vociferous opponents of the AHCA—says Paul Ryan and leadership have yet to reach out to him. If GOP leadership doesn’t want to work with critics of the law to improve it, can they really be serious about their efforts to do so?

President Trump was not my preferred choice during the 2016 election cycle, but after he won, I had hope Paul Ryan and the GOP would hit the ground running on conservative healthcare and tax reform for 2017. The AHCA has dashed those hopes. It’s also destroyed my faith in Ryan. If Ryan and leadership can’t get healthcare reform right, how can I trust they will on tax reform?

As a tax wonk, I like the “Better Way” plan. It’s not perfect by any means, but it’s far better than what I expected the House Ways and Means to produce. It could be the closest the GOP has come to a transformational tax reform plan since the late 90’s when the flat tax was all the rage. But I fear Ryan can’t corral the support necessary to get the bill he wants. And I further fear sniping factions within the GOP will water-down the kind of bold tax reform the “Better Way” blueprint envisions.

It’s hard to be optimistic in this world. As a Christian, I don’t put my hope in any government or elected official. But I do hope for a government that operates well and in as limited of a way as necessary. After waiting eight years for a GOP president and congress, it’s sad to think it may amount to nothing more than letting Obamacare remain and passing a “tax reform” plan that just tinkers around the edges.

What this country needs more than ever is bold reform. Based on how 2017 has gone, I’d be surprised if we get any reform at all.