The continuing debate over how to repeal and replace Obamacare has stumbled over what to do with people who got health insurance through that legislation. Neither the House nor the Senate version has gotten it right, placing passage of the GOP’s core promise for seven years in jeopardy.
This job would be much easier if only the Republicans would follow Ronald Reagan’s principles — which were not what many think they are.
Contrary to myth, Reagan wasn’t an anti-government zealot. As he told one 1958 audience, he wouldn’t repeal most government welfare programs “regardless of the price.” He told another audience in 1961, that “any person in the United States who requires medical attention and cannot provide for himself should have it provided for him.” To that end, he supported the Kerr-Mills Act, which gave federal grants to states pay for health care for poor senior citizens. He even told one friend that if “the money [the bill appropriated] isn’t enough, I think we should put up more.”
He didn’t change those ideas as he grew older. He continued to express support for the idea that no one should be denied medical care for lack of funds in letters as late as 1979. As president, he signed the Emergency Medical Treatment and Labor Act, which requires hospitals to stabilize a patient in an emergency condition regardless of that person’s ability to pay.
Reagan wanted smaller government, but he raised California’s taxes in 1967 rather than slash welfare and Medicaid spending. His 1971 welfare reform bill that removed the able-bodied from the rolls also increased welfare checks for people staying in the program by 43%. He was proud of this and called it “giving them a raise”.
As president, he made clear that budget cutting would only target those who didn’t need government help. People who “through no fault of their own” relied on taxpayer support — “the poverty stricken, the disabled, the elderly, all those with true need” — could “be assured that the social safety net of programs they depend on are exempt from any cuts”.
Reagan even raised taxes as president to keep safety nets intact. His 1983 bipartisan reform to save Social Security, for example, raised Social Security taxes and subjected part of wealthy seniors’ Social Security payments to the income tax. He was especially supportive of the latter provision, arguing it was “a step toward correcting a mistake in the program — there should have been a means test from the beginning”.
Reagan’s core beliefs always prioritized helping people in need over saving money or abstract principles regarding liberty. Today’s Republicans, however, often seem to have exactly the opposite priorities.
Both the Senate and House bills capped federal government contributions to Medicaid, which provides medical care to the poorest Americans. But contribution caps to the states over time will force the states to change their programs, perhaps endangering some people’s health care coverage.
House Speaker Paul Ryan’s prior Medicare reform proposals have run into the same challenge. Ryan wants to turn Medicare, which provides health insurance to those 65 and older, into a program that only guarantees the elderly receive a set amount of money for health insurance rather than ensures they get all the care they need regardless of the cost. This would prevent expected large spending hikes by capping the federal government’s contribution to Medicare. But the specific programs he has presented have been criticized as endangering the ability of many seniors to purchase the care they will need.
In both cases, Ryan seems to prefer eliminating fiscal risk for the nation over eliminating health risk for people.
Ronald Reagan would never have done that. As he told Congress 1982, “we can be compassionate about human needs without being complacent about budget extravagance”. Reagan-inspired entitlement reform would balance both goals, placing human need before budget savings whenever possible.
Reagan likely would have wanted enough funding to give people meaningful access to health care while giving states the leeway to give their citizens affordable plans. A health-care bill that focused less on controlling costs and cutting taxes and more on these ideas would both pass public muster and end up cutting spending in the long run.
Other major entitlements can also be reformed by focusing on need first. Why do people with millions of dollars in savings get roughly the same Medicare subsidies as those who are barely scraping by? Why shouldn’t well-off seniors have all their Social Security checks subject to income tax as well as have the growth rate in their benefits cut? Why should wealthy farmers qualify for farm subsidies that guarantee them a high income when the rest of us take our lumps if our luck turns bad?
Reagan supported these measures and more at one point after this turn to the right. Why can’t today’s GOP try these first rather than risk that those who need help will go without?
Ronald Reagan was beloved by Americans, and not just by conservatives. His compassionate conservatism earned the support of millions of Democrats who wanted what he offered. “He isn’t like a Republican,” one worker said in 1984. “He’s more like an American, which is what we really need”.
If today’s GOP can act more like Reagan, they can solve our country’s problems and become the majority party for years to come. If they don’t, they risk alienating the millions of Democrats and Independents whose votes in November put Trump in the White House and saved the GOP Senate majority.
And that would lead to Democratic control and much larger government as far as the eye can see.
Henry Olsen is the author of “The Working Class Republican: Ronald Reagan and the Return of Blue-Collar Conservatism” (HarperCollins, 2017). He is a senior fellow at the Ethics and Public Policy Center.