On Tuesday, I wrote about the GOP's Obamacare jiu-jitsu: they got Democrats to abandon their dream of single payer, embrace a basic approach to health-care reform originally designed by Republicans, and do the hard work and pay the high electoral price of passing and implementing the law.
The problem is that Republicans experienced this historic policy success as a crushing defeat. They're jiu-jitsu masters who believe themselves to be pathetic losers.
If this all had been a devious plan, the next step would be obvious. Now that Democrats did the hard work of passing Romneycare into law and Republicans have won some elections based on the backlash, they can adopt the policy polls say voters actually want: mend Obamacare, don't end it.
The basic structure of Obamacare is perfectly amenable to many Republicans — it was, after all, originally developed by the conservative Heritage Foundation and given legislative form by Senate Republicans. But since Democrats wrote and passed the version that became law, they built on that structure in ways Republicans didn't like. They raised taxes, expanded Medicaid, heavily regulated private insurance products, and so on. Which is all to the good for Republicans: they can disown everything people hate about Obamacare and build on the parts that they like.
The alternative is going to be disastrous for Republicans in 2016: by then, around 30 million people are likely to depend on Obamacare for insurance coverage in some way. A presidential candidate promising to end that coverage by repealing the law rather than improving it through conservative reforms is going to go down in flames. That's particularly true because they'll be running against a Democrat, like Hillary Clinton, who will be promising to fix whatever people don't like about Obamacare.
What state officials (and our conservative representatives in Washington) need to do is leverage (jiu-jitsu) Obamacare's next chess moves and offer more fiscally responsible and freedom-loving alternatives or reforms, such as some version of Avik Roy's "Obamacare jiu-jitsu" and his four-step solution to tackle the U.S. health-care behemoth. It includes:
Step 1: Replace or fix Obamacare's exchanges
It starts by improving the market orientation of Obamacare's insurance exchanges. With the states' pressure and even the leverage offered them via last summer's Supreme Court decision, they and Republicans in Congress can reduce the excessive mandates, regulations and subsidies in Obamacare. Utah, for example, created a health-care exchange that is far more palatable and market-oriented than the one offered through Obamacare.
Step 2: Migrate Medicare enrollees into the exchanges
The next step would be to move Medicare patients into Obamacare's (reformed) exchanges. Roy explains, "For example, Congress could agree to raise Medicare's eligibility age by three months every year for the foreseeable future [and] transfer the ‘dual eligible' population - seniors who are enrolled in both Medicare and Medicaid - onto the exchanges." Roy adds, "In effect, over time, this would gradually introduce premium-support-style reforms into the retiree population, without requiring Congress to get bogged down in complicated reform legislation."
Step 3: Let more people buy insurance on their own
The third step would be that "Congress could consider reforms of Obamacare's employer mandate - for example, exempting businesses with fewer than 200 employees, or eliminating it entirely - so as to stimulate economic growth while improving the market for individually purchased health insurance."
Step 4: Offer Medicaid patients a way out of that broken system
The last step would be to "move the Medicaid population into the [reformed] exchanges. ... Another approach could be to give Medicaid's long-term care program back to the states, in exchange for federalizing Medicaid's acute-care, pediatric, and dual-eligible populations."
"When I think of Obama and Obamacare," Norris concludes, "I can't help but think of the words of Rickson Gracie, retired Mixed Martial Arts world champion and a member of the renowned Gracie family, who once said, 'If size mattered, the elephant would be the king of the jungle.'" I have no idea what that means in this context but I certainly wouldn't say that to Chuck Norris's face.
Anyway. Republicans should probably listen to Chuck Norris. Surely a man this good at roundhouse kicks is a sound legislative tactician: