Protesters outside a Republican party fundraiser in Elizabethtown, Ky., June 30, 2017. (Reuters photo: Bryan Woolston)

If they can’t articulate their vision of a free-market system clearly and appealingly, Republicans will struggle to win the debate.

The current health-care debate is often distilled into a series of binary choices for public consumption: good or bad, healthy or sick, help for the rich or help for the poor. As a result, a growing number of Americans are starting to believe that the GOP’s health-care legislation is a cruel ploy to hurt millions of Americans. This is in large part a messaging failure: Good policy must be sold with good arguments, and Republicans have not articulated their own vision of what the American health-care system should look like.


That’s not to say that such a vision doesn’t exist, of course. A conservative approach to health policy would ideally create a thriving market system, with a sufficient number of insurers to compete for consumer business leading to low prices and quality coverage. A targeted safety net would protect the truly vulnerable and tax credits would be provided on a sliding scale to those who need help purchasing private coverage. Fewer regulations would mean a variety of insurance choices to fit individual needs. The use of health savings accounts would be expanded so that people could take control of their own health-care decisions. And lower taxes would spur economic growth, in turn creating more jobs and upping private-coverage rates.

This overview is simplistic, and the details of any health-care bill certainly matter. But the fact remains that conservatives have failed to effectively convey to the American people the core belief they bring to this debate: government is not the most efficient way to provide quality health care. Democrats communicate their health-care position in understandable sound bites with obvious surface appeal; it is essential that Republicans do the same for their own vision of a robust, free-market health-care system.


Health-care policy is extremely complicated. Coverage numbers should not be discounted, designing programs that prioritize access to providers is essential, and regulations can help individuals receive essential services at reasonable prices, but debating these crucial details should not come at the expense of laying out what Republican legislators hope to achieve with the repeal and replacement of Obamacare. Each and every policy proposal should be connected back to the larger GOP health care vision, and so far that has not been the case.

This messaging problem can be seen first-hand in the debate over the future of Medicaid. It is possible to reform that program so it’s both compassionate and fiscally disciplined; these are not mutually exclusive concepts. Conservatives need to explain not only why Medicaid spending is unsustainable, but also why this looming fiscal crisis will eventually hurt the very people the program was intended to help. Most of the ACA’s coverage gains have come from expanding Medicaid eligibility to working-age, able-bodied adults. These increases in coverage have come at the expense of those the program was originally designed to serve: the poor, pregnant women, children, the elderly, and the disabled.


President Obama incentivized states to expand the program by offering incredibly generous federal funding. The federal government provides between $1 and $3 for each dollar a state spends on a traditional Medicaid beneficiary. By 2020, it will pay $9 for each $1 a state spends on the beneficiaries of the ACA’s expansion. This gives states a good reason to prioritize the able-bodied adults the law added to Medicaid’s rolls over the neediest individuals. Governors facing already-tight budgets have favored the increased funding that comes with expansion over maintaining and instituting programs for traditional Medicaid patients, who arguably need them more. It makes little sense to give adults with the capacity to work more government support than the disabled, pregnant women, and those living below the poverty line.

Democrats communicate their health-care position in understandable sound bites with obvious surface appeal; it is essential that Republicans do the same.


From a fiscal standpoint, Medicaid is already eating up large portions of both state and federal budgets. As Medicaid spending grows, there’s less money available to spend on valuable infrastructure projects, education, and defense. Such an expensive entitlement program should be open to as much scrutiny as any other line item in the federal budget. In its current form, the GOP health-care proposal would still contribute trillions of dollars to the program in the future while slowing the program’s current projected growth to put it on a more sustainable path. Meanwhile, states would be able to design programs with fewer onerous federal mandates, and thus prioritize local innovations that decrease costs and improve care.


These reforms would be paired with a new tax-credit system to subsidize private coverage for those below the poverty line. Medicaid doctors get paid cents on the dollar, limiting the number of providers who are able to see patients. Medicaid enrollment has grown, but the pool of doctors available to serve the program’s beneficiaries has not expanded in kind. Encouraging private coverage would ensure that more people get access to needed, quality care.

The Republican response to the broken promises of the ACA has been largely reactionary. Labeling their legislation as only a rescue mission to save a deteriorating system, they have failed to articulate why their plan for health care is better. Unfortunately, the GOP’s ability to sell its ideas to the public is greatly constrained by the bills introduced so far. The legislation offered is not the transformative, market-based home run it ought to be. This is due both to the legislative constraints of the budget-reconciliation process and to the inability of the moderate members of the caucus to agree to implement needed reforms.


Voters are unhappy with Obamacare, but they must be offered an alternative that both works and resonates. Conservative lawmakers need to begin explaining why private-coverage gains are better for families than an expansive government program. Only then will the public be convinced that free-market reform is both necessary and beneficial.