(This article was adapted from a previous article published in Forbes Nov. 3, 2010)
The key question for Republican leaders after Tuesday's election results is what can they do now to turn their opposition to ObamaCare into governing reality.
Hill Republicans should challenge the next Congressional Budget Office director to re-examine several of CBO's previous budgetary assumptions (particularly involving whether many employers will drop private coverage.) Smarter incentives to reward responsible behavior and better-targeted protections of the most vulnerable portions of the population are essential pillars of more vigorously competitive health insurance markets. Republicans should replace unpopular insurance coverage mandates with a pledge of protection against coverage exclusions for pre-existing health conditions that is limited to those who remain continuously insured over time. This approach needs to be bolstered with the backstop of a high-risk pool safety net that is subsidized sufficiently (though not lavishly) by taxpayers in an income-sensitive manner. Consumers failing to find coverage on the terms they want or can afford from traditional sources should be able to turn to information-heavy/regulation-light health exchanges that are organized by states in a more competitive, choice-expanding manner than ObamaCare would allow. Opening up sale and purchase of health insurance across state lines also would lower the regulation-added costs of health insurance to some extent (probably about ten to fifteen percent on average), as long as such competition among various state brands of regulation is driven by consumer choice and provides sufficient safeguards.
Thomas P. Miller is a resident fellow at AEI.