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CAPITOL PERSPECTIVES Republicans: Stop Allowing Vocal Ideologues To Dictate Health Policy W hile it is understandable why many members of Congress fear crossing their ideological base, it is high time for Republicans and Democrats alike to disregard ideological rigidity and come together on reasonable and modest reforms that can strengthen the health system and bring greater efficiencies. For decades, when Republican leadership constructed legislation, attention was focused on maintaining support of moderate Republican members, often in Democratic-leaning suburban districts. But three recent developments gave impetus to the conservative base driving negotiations and legislation within the caucus: or "RINOs" (Republicans in name only) as they dub them — sprang into action. They issued alerts to their members and threatened retribution to any Republican who supported Majority Leader Cantor's bill on the issue. The bill also drew the ire of AARP and several left-leaning groups, so bipartisan consensus could not be achieved, and a floor vote has been indefinitely delayed. The issue is endemic of a larger problem that Republicans confront in approaching health policy. There is a substantial faction of the Republican party and the base that would like to either repeal Obamacare in its entirety or require the entire statute be implemented precisely as written and watch with 1. Redistricting, whereby state legislatures glee as the Democrats' law fails to deliver half gerrymandered district lines to make of its promises at twice the cost. Two score and Republican districts more conservative counting repeal votes in the House have been (and Democratic districts more liberal). unsuccessful in getting the Democrat-controlled 2. The Supreme Court decision to allow thirdSenate to move. party groups to spend unlimited "indepenNow Tea Party activists Senators Ted Cruz John McManus, dent expenditures" educating the public on (R-TX) and Mike Lee (R-UT) are demanding that The McManus Group certain issues or members' votes. jmcmanus@mcmanusgrp.com Congress defund Obamacare this fall when it 3. The rise of the grass-roots Tea Party. votes on the appropriations bills that fund the federal government. Even if that bill passed the Republicans are now more concerned about a primary Senate with some Democrat support, it would be vetoed by challenge from their base than a Democratic challenge from President Obama and a 2/3 majority from both chambers the center/left. The primary defeat of prominent main-street would be required to override. They simply don't have the Republicans such as Senator Bennett (R-UT), Rep. Castle votes, and bringing the government to the brink on an issue (R-DE), and Rep. Stearns (R-FL), among others, struck fear in that has been settled by the Supreme Court and the 2012 a number of Republicans and now drives their decision mak- election makes no sense. ing on many matters, but healthcare above all else. This explains why the Republican House leadership was WHAT SHOULD CONGRESS FOCUS ON THIS FALL? forced to scuttle a modest bill that would have removed funds The Obama administration is scrambling to implement the from an Obamacare slush fund in order to finance high-risk greatest change to healthcare policy in the history of the pools for uninsurable individuals, another Obamacare initia- country, but by all indications, it will not be ready, and chaos tive that had run out of money because too many sick people will roil the health sector. • The Supreme Court made the Medicaid expansion signed up. The bill was a clever initiative because it simultaneoptional to states, and only 24 states with 5.4 million ously 1) defunded a slush fund for prevention that Secretary of the 15 million potential new enrollees have affirmaSebelius was tapping to establish federal health exchanges in tively announced they will proceed with the expansion. those states refusing to set up their own exchanges and 2) addressed a real policy problem with Obamacare, which had • More troubling, 27 states have indicated they will not low-balled the resources it would take to provide assistance establish their own exchanges, which will offer subsito uninsurable individuals through high-risk pools — a policy dized insurance policies available to individuals above proposal Republicans had embraced for years. the poverty level. A recent Government Accountability The Club for Growth and Heritage Action — two notoriOffice report found that implementation of the federal ous conservative groups known to drop tens of millions of exchanges for those 27 states by October 1 is uncertain dollars on Republicans they find not conservative enough, 10 LifeScienceLeader.com September 2013