Republican Party’s Obamacare crisis: The logic of the president’s health care plan offers a solution for the GOP’s future.

What the GOP Could Learn from Obamacare

What the GOP Could Learn from Obamacare

Who's winning, who's losing, and why.
Sept. 20 2013 3:35 PM

What the GOP Could Learn From Obamacare

The problem the Republican Party is facing right now is just like the one the architects of Obamacare once faced.

John Boehner and Barack Obama
In the manner in which President Obama must broaden the insurance pool to cover those with pre-existing conditions, John Boehner and his fellow Republicans must broaden their primary-voter pool to keep the party from becoming too extreme to win elections.

Photo by Dennis Brack/Pool/Getty Images

Even though it may be suicidal for their party, congressional Republicans are threatening to shut down the government in order to defund Obamacare. They feel compelled to take this highly risky step because Republican primary voters are so conservative that any hint of moderation could be politically fatal.

Ironically, the problem now facing Republicans is similar to the one the architects of Obamacare faced several years ago. A central goal of Obamacare is to ensure that persons with pre-existing conditions are not denied access to affordable health insurance. But prohibiting the exclusion of persons with pre-existing conditions raises the specter of a health insurance death spiral. Here’s the logic: If health insurance plans are required to enroll high-cost individuals, premiums will go up substantially. Healthier (and less costly) individuals will then leave the plans, while high-cost individuals, who may have no other option, remain. As a result, premiums will rise even higher and even more low-cost individuals will leave. Before long, the insurance plans will face bankruptcy.

The Republican Party faces a similar phenomenon. In many regions, Republican primaries nominate far-right Senate and House candidates. These candidates, whether they win or lose, drive moderate voters to leave the Republican Party. Conservatives then dominate the party to an even greater extent and nominate even more extreme candidates, thus driving away more moderates. Bankruptcy follows in the form of lost elections.


Of course, in many states and House districts, Republicans are so dominant that they cannot lose no matter what candidate they put forward. But in the last two election cycles, Republicans lost Senate seats in Colorado, Delaware, Indiana, Missouri, and Nevada because of the ultraconservative candidates they nominated. They may have lost a seat in Maine because of the threat that a fringe conservative could successfully challenge Sen. Olympia Snowe. And they lost several House seats in 2012 because of the extreme candidates nominated and elected in 2010.  Furthermore, Mitt Romney’s campaign was hurt by the positions he felt compelled to take, especially on immigration, in the presidential primaries, and the current antics of congressional Republicans may damage any future GOP nominee in 2016.

How does the Republican Party counter its death-spiral problem? Earlier this year Karl Rove proposed using the financial clout of wealthy mainstream Republicans to prevent the nomination of extreme candidates. But this is unlikely to work, in part because the party’s far-right wing has plenty of its own rich backers.

The best solution for Republicans may be found in Obamacare.

Obamacare abolishes pre-existing-condition exclusions and requires health plans to enroll high-cost  individuals. But it seeks to ensure that health plans have a broader subscriber base than just those who are expensive to insure. It imposes a mandate and provides generous income-based subsidies in order to induce healthier individuals to join the plans, too.

The Republican Party could take an analogous approach. It could broaden its primary voter base by opening its primaries to independent voters or, at least, to those independent voters who have registered as Republicans at some point during the last two decades. By becoming more inclusive, it would become more competitive.

The present Republican state party leaders aren’t likely to embrace this approach. But if Republicans continue to lose key elections, some leaders will begin a campaign to get moderately conservative independent voters to register as Republicans to take back the party. It will be a long slog; change is hard. Why do you think it has taken so long to provide health insurance for all Americans?

Joe Onek, a principal at the Raben Group, has served as senior counsel to House Speaker Nancy Pelosi and deputy White House counsel to President Carter.