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Why Conservatives Are Losing Health Care Policy Battles

The GOP pledged to "Repeal & Replace" Obamacare. They won the election but lost the policy fight. There's a reason.

Republicans lost the debate about passing Obamacare (the Affordable Care Act). They lost the debate about implementing it, including as the law took full effect in 2014. Then they lost the battle to “Repeal and Replace” despite Trump and a GOP Congress actively campaigning on the pledge.

Why? Here’s one reason:

Too many conservatives, including both policymakers and pundits, don’t understand enough of the health policy and health care industry in question.

Repeal and Replace was a joke, in part because despite campaigning on it, no one had a sound plan to do so. From Donald Trump not-so-surprisingly saying “nobody knew health care could be so complicated” to Lindsey Graham simply saying out loud the reality for most GOP Members of Congress as Repeal and Replace went down in flames, it wasn’t pretty:

“I thought everybody else knew what the hell they were talking about, but apparently not,” Graham clarified, adding he had assumed “these really smart people will figure it out.”

Smart people would have been good.

Sadly, there were too few. I wrote in a previous professional life as Repeal and Replace was dying about what the GOP was getting wrong as health care and its politics have changed.

Key among those errors is one Republican candidates on the trail in competitive races finally seem to be embracing now: access to coverage with no ban on pre-existing conditions is broadly popular across the spectrum of American politics:

Ok, fine, you might be saying. Repeal and Replace is in the past. What about today?

Yeah, about that.

Recently the explainers at Vox published a piece about rising costs in employer-sponsored health plans, including the issue of rising deductibles in the last decade.

Many of our conservative friends were quick to jump on the snark train, calling out the article for failing to mention Obamacare’s impact. Just a sampling of the list includes:

These are all smart people. One problem.

They’re all wrong here.

Obamacare did a lot to increases costs, drive up premiums, and result in higher deductibles in the individual market, which the law heavily regulates.

Obamacare did precious little, however, to drive up costs in the much larger employer market, which was clearly the subject of the Vox discussion.

Indeed, the data is pretty clear: deductibles have been steadily rising in the employer market for years, long before Obamacare.

Premiums in the employer market have the same, rising, long-term trend, also with nary a blip for Obamacare:

Obamacare has had very little to do with the rising cost of employer coverage, which is being driven inexorably by the rising cost of providing health care in America (and neither Obamacare nor Repeal and Replace addressed that huge issue).

Likewise, rising deductibles are a function of employers choosing to spread more costs to employees, because those employers are increasingly reaching a major pain point on the cost of benefits.

Yet, many smart conservatives were out with a horribly incorrect assessment, likely because it just sounded right … and busting on Vox is like busting on that younger cousin you don’t like at extended family gatherings. It’s easy, and fun to do.

Well, health care is indeed complicated (ask Trump). I spent eight years in the health care industry, including leading communications for a medium-sized health insurer on all manner of Obamacare-related topics to consumers, employers, policymakers, the media, etc. And one of the overwhelming takeaways I had from that whole experience is how badly too many fellow conservatives and Republicans understand the health care system and health care policy.

To be exceedingly clear, Democrats and progressives have many problems as well.

They didn’t understand the industry they were trying to regulate with Obamacare, which is why individual market premiums soared dramatically, hammering everyone not aided by expensive, federal subsides.

Meanwhile, Obamacare’s solution for small employers was a total bust because Democratic policymakers understood even less about that market.

And progressives have little idea what they’ll unleash with serious Medicare-for-All proposals when they find out the interest groups that will oppose the idea most vociferously are the American Hospital Association and American Medical Association.

But, that doesn’t excuse ignorance on the right. If we’re going to win some of these health care policy debates at some point, we should do better at understanding the subject of that debate.

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