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How the Senate can make GOP health bill less 'mean'

  • President Trump wants the GOP Obamacare bill to leave fewer people without coverage.
  • But 'coverage' is a foolish and empty goal, what we want is more actual health care access.
  • Boosting risk pools and allowing more insurance choices is the 'nice' way to achieve that.
Senate Majority Leader Mitch McConnell
Jonathan Ernst | Reuters
Senate Majority Leader Mitch McConnell

It doesn't get clearer than it did earlier this week when President Donald Trump was quoted as telling Republican Congressional leaders that he believed the existing House Obamacare replacement bill was "too mean." And this time, there wasn't even a denial from the White House when that comment was quickly reported in news media.

Okay, so how can Republican Senators make the bill "nicer" without sparking an all-out conservative revolt?

Well, first I'll try to explain what President Trump considers to be "mean."

It seems he's talking about the 23 million Americans predicted to lose their insurance coverage if the current AHCA becomes law. That's not to say the president doesn't recognize how mean the collapse of Obamacare would be for the millions of people who lose coverage if it continues to implode in state after state. But the threat of those millions of "Obamacare orphans" has always been the understandable fear for the White House and the Congressional Republicans as a whole.

With that in mind, my simple guess here is that Republicans will try to make the Senate plan cover more people the same way the re-worked House bill did. That is, by increasing subsidies for more people to buy insurance and making some added contributions to the risk pool programs for people with expensive pre-existing conditions.

In short, that's the wrong way to go.

"The threat of those millions of "Obamacare orphans" has always been the understandable fear for the White House and the Congressional Republicans as a whole."

In fact, this path takes one of the worst parts of Obamacare and makes it even worse. Remember that the GOP bill eliminates the individual mandate to buy health insurance. It's true that the number of younger and healthier Americans who complied with the mandate fell far short of Congressional Budget Office and Democrat projections.

But those who did sign up provided at least some of the needed revenue to pay for the Obamacare insurance subsidies. Now the Republicans are looking at expanding subsidies while cutting off a key aspect of the funding. Conservatives and liberals alike can agree that's madness, and they do.

The better way to make this bill nicer is to not to focus on the aggregate numbers of insured and uninsured. That's a red herring that puts the goal of preserving nominal "health coverage" above the much more important goal of improving access to actual health care.

As we've learned from the steep Obamacare plan deductibles and the reduced Obamacare plan choices across the country, being "covered" and getting care are two different things. The Trump administration and the GOP Congress cannot be allowed to get away with simply claiming that more people having health insurance is a good or nice thing when that insurance doesn't make getting care any easier or less expensive.

By contrast, the Senate has three better paths to being less mean.

The first is Senator Ted Cruz's plan to focus much more funding on the risk pools and make them provide care to the smaller number of Americans with expensive conditions who truly cannot afford care. Cruz's plan is based on the same philosophy as Ronald Reagan's successful welfare reforms when he was Governor of California.

Reagan called for the truly poor to "get a raise" and give them that raise at least in part by removing too many marginal welfare recipients from the rolls. Instead of providing more subsidies to able bodied, middle class people to buy potentially overpriced insurance, it would be nicer if that money was spent on covering more of the truly poor and very sick. Spreading out the government largesse only promotes political, and not societal, goals.

The second nicer thing to do would be to make it easier for states to allow insurance companies to provide lower cost insurance plans. The current AHCA forces states to apply for waivers if they want to allow their residents to buy the bare-boned, major medical plans that make sense for younger and healthier people. Revenues from the sales of those kinds of plans, plus the fiscal quarantining of pre-existing condition patients via robust risk pools are much more likely to produce the less mean result of lower overall premium costs for everyone else at any age.

And the third nice thing the Senate should consider either in this bill or in a follow-up measure is to work hard to remove the barriers to entry that plague almost anyone who wants to get into the health care field. The only way to really lower health care costs and increase access are increased supply of health care and technical innovations that eliminate overhead.

Washington should move to make it less expensive to be a doctor or a nurse by eliminating repetitive regulations, making meaningful tort reform, and changing the student loan system to favor medical and nursing students who commit to filling jobs in under-served areas. Again, shoving all of that into this GOP health bill now may be a tall order, but it's a necessary path to take once the AHCA is passed.

Something President Trump and too many people in politics don't seem to understand is that government handouts aren't nice. In the case of Obamacare, the handouts did not lead to lower health insurance costs in the relatively short run and they never provided much choice.

Simply copying Obamacare's essential mistakes won't make the GOP replacement bill less mean, it'll make it meaner for the actual taxpayers who will have to pay more and more to keep it afloat.

The nice and compassionate part of the Republican efforts should focus on the risk pools, everything else shouldn't be concerned with nice or mean labels and simply go with what will work.

Commentary by Jake Novak, CNBC.com senior columnist. Follow him on Twitter @jakejakeny.

For more insight from CNBC contributors, follow @CNBCopinion on Twitter.