By: Michael Hamilton
Sen. Ted Cruz (R-TX) will dominate Sen. Bernie Sanders (I-VT) in tonight’s CNN debate over the merits and demerits of Obamacare, as long as he does three simple things. Cruz should take a populist play from Trump’s playbook, put the so-called uninsurable population at ease, and myth-bust Medicaid expansion, the failed messiah of the Affordable Care Act (ACA).
CNN’s many faults notwithstanding, tonight’s showdown is a brilliantly conceived contest between runners-up in the presidential primary elections that cemented then-future President Donald Trump and former Secretary of State Hillary Clinton as their parties’ respective nominees.
Unlike a vice-presidential debate, tonight’s confrontation is not a duel between lieutenants. Cruz is not Trump’s man. Sanders is not Clinton’s. Neither senator is strapped with the obligatory role vice presidential candidates have of balancing out the ticket by apologizing, reinterpreting, rephrasing, and papering over the campaign blemishes in his respective presidential candidate.
On the contrary, each senator has fairly bludgeoned his party’s victor at one time or other. Unlike most of his fellow failed presidential candidates, each stated his intentions at least once not to endorse the upstart Trump or crony Clinton. The senators even stuck to their guns a short while before deciding this was fruitless to their causes.
And it is the senators’ causes that distinguish them from Trump and Clinton, as well as from Vice President Mike Pence and former vice presidential candidate Sen. Tim Kaine (D-VA). Cruz and Sanders were the ideological puritans among the 2016 presidential contenders. If ideology were theology, it would be fair to say Cruz lost to the dubious and untested new convert Trump, and Sanders lost to the elitist apostate Clinton (whose cash-infused cronyism and scandals undermine the progressive religion).
Tonight Cruz and Sanders will emerge from their righteous corners, bump fists, and call down fire from heaven (or up from hell, depending on your persuasion) to consume the offering Obama hath placed on the altar, the same offering Trump has failed so far to remove: Obamacare.
Winning is important because a Cruz victory could give Trump and Congress the courage they need—and which they claimed to possess during their campaigns—to repeal ACA within weeks or months instead of years.
Here’s how Cruz can win:
Play to Populism. There never was a more perfect opportunity for Cruz to steal Trump’s populist thunder than tonight. For the first time, people can have their cake and eat it too. Trump’s base of disenfranchised Muricans can and should rally around Cruz, because unlike in 2016, they do not have to choose between them.
Cruz should call to Trump’s base with consumer-driven health care solutions. The population that voted for Trump are health care consumers. So are the people who voted against Trump. Consumers like options and the freedom to choose for themselves which products and services offer the best value. Cruz (and Trump) should buy their love—not with money but with choices over health care that Obama took away.
There is more than one way to throw bread to the crowds at the circuses. Freedom to choose is more precious than federal subsidies. Cruz should hammer the point Trump and Congress appear to be missing: Repealing ACA without a replacement plan ready would launch waves of state-based, free-market health care reforms resulting in greater health care access, quality, and value.
State lawmakers are prepared to enact these reforms, in part because The Heartland Institute, with its more than 1 million state legislative contacts per year, is constantly writing about them, most recently in the two-pager “10 Health Care Reform Options for States,” published February 1.
Assure the Uninsurable. Given Trump’s cavalier promise-making and Republican lawmakers’ fear of political suicide, there’s no way Trump and Congress will repeal Obamacare without a plan in the works to help the so-called uninsurable population. These uninsurables are potent ammunition for Sanders and the Democrats, who launch them like human cannonballs at Republicans whose policies would improve their quality of life.
So Cruz should concede early and often that government is going to help uninsurables pay for health care. Atlas will not shrug all the way. The federal government or state government or (most likely) a combination of each will pay.
How they pay, however, will make all the difference. Obama tried serving uninsurables by distorting the entire insurance market with onerous, expensive mandates on individuals, employers, and insurance companies. We’re living with the result.
Trump can help uninsurables by breaking them away from insurables. A market of insurables-only would thrive when freed from ACA mandates and enriched by state-led, consumer-driven health care reforms. Meanwhile, newly formed pools of uninsurables could receive taxpayer assistance less circuitously and far more efficiently than by turning an entire industry inside out.
Myth-bust Medicaid Expansion. This is a three-for-one. First, the claim 20 million people gained insurance under Obamacare a myth. The real number is closer to 16.5 million, as Ed Haislmaier, a senior research fellow at The Heritage Foundation, explained at a House Budget Committee meeting on January 24. Second, “Medicaid accounted for 81 percent of the incremental growth in enrollment in 2016,” and roughly the same goes for 2014 and 2015, according to Haislmaier.
So Medicaid expansion is great, right? Not even close, because (and third) every state to expand Medicaid under ACA has blown its budget—some states by a factor of four. This is true despite the federal government paying up to 100 percent of the cost of newly eligible enrollees in Medicaid expansion states. States and the federal government underestimated how many people would sign up for this entitlement program. The Centers for Medicare and Medicaid Services (CMS) have consistently underestimated what Medicaid expansion would cost.
CMS has also blocked states from implementing even negligible cost-sharing, premium, and copay requirements for able-bodied Medicaid expansion enrollees. Repealing this centerpiece of Obamacare would free states to make Medicaid compete.
Play the populist game, reassure the uninsurable, myth-bust Medicaid expansion—and Cruz has it. What could go wrong?
— Michael T. Hamilton ([email protected], @MikeFreeMarket) is a Heartland Institute research fellow and managing editor of Health Care News, author of the weekly Consumer Power Report, and host of the Health Care News Podcast.
This piece was originally published as part of the Heartland Institute’s weekly series Consumer Power Report. If you would like to receive further news on all the latest health care issues, please consider subscribing.