For the new Congress, a vote to repeal the Affordable Care Act (ObamaCare) is a civic obligation and a practical necessity. It is equally as important for the new Congress to advance a new path for health reform.

Full repeal is a civic obligation because most, if not all, of the newly elected majority have promised to oppose the unpopular law. They are honor-bound to keep their promises to the people who elected them. Those senators who have been protected from such a recorded vote for six years by the former Senate majority leader will now have a chance to make their position clear as well.


Of course, the president certainly will veto a full repeal of his signature legislative accomplishment, but that is quite beside the point. In a democratic society, elected representatives are to be accountable to the people, not to the president.

Voting for repeal is a practical necessity, as well. This law is profoundly unfair. It has forced millions of Americans out of coverage they liked and wanted to keep. Moreover, its key provisions are simply unworkable.

Pressure to address the law's highly unpopular mandates forced the administration to broaden the hardship exemption from the individual mandate and soften its enforcement while delaying implementation of the employer mandate. Administering the law's hideously complex system of insurance subsidies (soon to include clawing back overpayments to low-income persons through the tax system) promises to be yet another managerial mess on the horizon.

The notion that this fundamentally flawed program can be "fixed" is fanciful. Any random amputation or adjustment to the law's unpopular parts, while perhaps worthy of consideration, will not resolve the fundamental problems with the law.

But one area where Congress could make a difference this year is in protecting taxpayers from the law’s ever escalating costs. The Congressional Budget Office (CBO) projects coverage expansions will cost $1.8 trillion over the next 10 years. That's more than double the original $898 billion estimate the CBO issued while lawmakers were debating passage. The real spending is likely to be higher than official estimates.

Any hopes that the law might reduce the deficit are crumbling. Alongside a push for full repeal, Congress should end ObamaCare's enhanced federal funding for the Medicaid expansion and insist on a hard cap on the subsidy scheme.

In reality, "fixing" any provision requires either dropping it or replacing it with a very different policy. ObamaCare reflects a vision of centralized government control of healthcare financing and delivery. Viable alternatives, of necessity, reflect a new vision: a system of health care financing and delivery based on personal choice and genuine market competition to control costs.

While getting from here to there, Congress must make sure that each and every change in health policy reflects this strategic vision. Within that positive framework, Congress should proceed step by step, subjecting each legislative measure to debate and deliberation.

And Congress had better get ready. The U.S. Supreme Court will hear arguments in King v. Burwell on March 4. It will then decide whether or not the IRS can create federal insurance subsidies in the federally run health exchanges. The justices are expected to rule by the end of June. If the court strikes down the IRS action, Congress will have an opportunity to advance an alternative. But lawmakers in Congress and those affected states will need to act quickly to keep the existing systemic problems from getting even worse.

The good news is that virtually all the proposals to replace ObamaCare are based on the fundamental principle of choice and competition — where personal ownership would unleash fierce competition among health plans and providers to control costs, while providing consumers with unprecedented choice and control of their healthcare.

For this Congress, the job is to live up to the expectation of the voters who elected them by making their opposition to ObamaCare clear with a vote, protecting taxpayers from the ever-rising costs of ObamaCare, and pursuing a market-based healthcare system that will work for all Americans.

Owcharenko is director of the Heritage Foundation's Center for Health Policy Studies, where Moffit is a senior fellow.