When did it first become clear that China would be welcomed back into the modern global economy by the United States? Most experts point to Republican U.S. President Richard Nixon’s 1972 trip to that nation as the moment when today’s Chimerica colossus was born.
Why? Because President Nixon was a strident anti-Communist who had spent his career opposing such measures. And yet, when people now say that “Only Nixon could go to China,” they mean that American / Chinese rapprochement only became inevitable when the most powerful political opponent of that policy decided to embrace it.
Likewise, two decades later, it only became clear that America’s liberal welfare system would be dramatically downsized when Democratic President Bill Clinton signed the Personal Responsibility and Work Opportunity Reconciliation Act. Then, and only then, could American citizens truly believe that their government had permanently ended “welfare as we know it.”
So why are these historical events relevant to the continuing debate about the Affordable Care Act (ACA)? Earlier this month, the eminent conservative think tank American Enterprise Institute (AEI) released a major report entitled Improving Health and Health Care: An Agenda For Reform. It was written by a panel of ten illustrious knowledge leaders, and (as expected) it called for the replacement of the ACA with a different set of guidelines and regulations.
Ostensibly, by replacing the current law, the major elements of the existing Act would be swept away. The mandate that citizens purchase health insurance? Gone. The ability to purchase insurance on a web site that lists all available options? Goodbye. The issuance of subsidies that make coverage more affordable? Farewell.
But before we conclude that the AEI actually recommended major revisions to our national health care policy, let’s review some of the elements of its proposed reforms. Its report recommends, for instance, the implementation of a “default enrollment program” that would enable state governments to place uninsured citizens into health plans without their advance consent.
What’s the difference between “mandatory enrollment” and “enrollment by default”? One might argue that the second type of system (i.e. the AEI’s preferred alternative) would place even more regulatory authority into the hands of government than the first type. Indeed, it’s hard to understand how it would actually reduce such authority.
Likewise, the AEI report proposes to replace the existing internet-based market exchanges with vaguely defined, state-regulated “mechanisms for consumer choice of plans.” It also proposes the replacement of the existing tax subsidies with “refundable tax credits.”
Would any of these changes address the fundamental impact of the law on the daily lives of American citizens? By simply redefining mandatory enrollment techniques as default enrollment techniques, market exchanges as consumer mechanisms, and tax subsidies as tax credits, the AEI appears to recommend the replacement of the ACA with a set of roughly analogous policies.
And so, just as Nixon’s embrace of China and Clinton’s endorsement of welfare reform certified permanent shifts in government policies, this month’s AEI report may have done precisely the same thing for Obama Care. By reading between the lines of the conservative think tank’s self-proclaimed desire to replace the ACA, we might be able to discern an implicit acknowledgment that the health law’s fundamental policies are now here to stay.