There’s no surer way to make a conservative health wonk huffy than by saying Republicans don’t have a health policy agenda. They insist they do, and an important part of it is high-risk pools: government entities that provide subsidized insurance to people with health risks who couldn’t be covered affordably in private markets.
Heartland Institute research fellow (and sometime Malaysia blogger) Ben Domenech says, “Of all the absurd memes repeated by the policy-bereft media these days, the idea that Republicans have no plan to replace Obamacare is one of the most irritatingly false.” One crucial plank of the replacement that Domenech identifies is “to support state-level pre-existing condition pools.”
In urging Republicans to stick with a repeal-and-replace agenda on the Affordable Care Act, Yuval Levin and Ramesh Ponnuru identify high-risk pools as an important component of a replacement: “Conservatives should commit to funding well-designed high-risk pools to cover the health-care expenses of sick people who have been failed by the current system.”
Too bad high-risk pools don’t count as a conservative health-care-reform plan because actual conservative elected officials aren’t willing to fund them.
This week, House Majority Leader Eric Cantor tried to bring up a much-reduced version of high-risk-pool support for a vote: the Helping Sick Americans Now Act. The objective was to show that Republicans aren’t nihilists and really do care about the uninsured. It was an empty gesture: Cantor’s bill would have diverted $3.7 billion over four years from Obamacare into a high-risk-pool program. That's less than 5 percent of the amount that conservative health policy experts Jim Capretta and Tom Miller think would be necessary for a robust program, so almost all sick people who don’t have insurance now would still have gone without under Cantor's bill.
But it was still more money for the sick and uninsured than Republicans are willing to spend. Majority Whip Kevin McCarthy had to pull the bill from the floor at the last minute because there weren’t enough Republican votes to pass it. Sahil Kapur of Talking Points Memo reports:
Earlier in the day, conservative GOP members spoke out against the measure, lamenting that it merely tinkers with the law when they wanted nothing less than repeal. Some said they opposed the high-risk pool portion of the law to begin with, despite its popularity among many Republicans and conservative health care wonks.
“Subsidizing health care is not what Republicans should be about,” Rep. Raul Labrador (R-ID) said at a Capitol Hill event organized by the Heritage Foundation.
Conservative groups were split on the legislation. While FreedomWorks and Grover Norquist’s Americans For Tax Reform supported it as an effort to undermine Obamacare, Heritage Action and Club For Growth urged lawmakers to vote against it.
That’s all you really need to know. As long as conservative writers on health care are producing talking points against Obamacare, they are a valued part of the conservative policy machine. But when they propose alternative methods to expand health-care access, Republicans ignore them.
Or worse, they mock them. Buzzfeed reports on an e-mail from Chip Roy, chief of staff to Texas Senator Ted Cruz, who trashed the Cantor bill as “a 'win' that only wonks on list-serves in DC get excited about.”
This is because Republicans don't actually want expanded access to health care. They want to politically undermine Democrats, and they want to protect policies that divert health-care dollars to seniors and doctors -- Republican constituencies -- instead of the poor.
Republican engagement with health policy is 100 percent cynical. And if conservatives who write about health policy for a living aren't cynics, they should be far more exasperated about that fact than they appear to be.
(Josh Barro is lead writer for the Ticker. Follow him on Twitter.)