GOP’s ObamaCare replacement: How Trump re-brands conservatism for the better
© Getty

The Republican-proposed ObamaCare replacement — the American Healthcare Act (AHA) — ought to serve as a case study in what listening and responding to the American people looks like.  

Republicans like Senator Rand PaulRandal (Rand) Howard PaulOvernight Defense: Lawmakers release compromise defense bill in defiance of Trump veto threat | Senate voting next week on blocking UAE arms sale | Report faults lack of training, 'chronic fatigue' in military plane crashes Senate to vote next week on blocking Trump's UAE arms sale McConnell in tough position as House eyes earmark return MORE have critiqued the AHA as not being purely, doctrinally conservative, but the plan actually represents a new brand of conservatism.  It is indeed conservative, but with an appropriate mix of populism, whereby the voice of the American people has the final say above narrow-minded ideology.


First, let’s consider the parts of the plan that are not doctrinally conservative — an advanceable refundable tax credit to purchase healthcare and Medicaid per capita allotment to states.  


Hardline congressional Republicans point to this as an entitlement, similar to the ObamaCare subsidies.  These tax credits could certainly be viewed as an entitlement — a benefit that citizens come to expect from government — but they are infused with the principles of free-market capitalism, which will not cabin consumers to exchanges with limited choice, one-size-fits-all plans.  Rather, consumers will be able to shop around the market for an appropriate plan, which should engender competition and bring down prices.  

While the tax credit and Medicaid allotment are free-market oriented, they are nevertheless an entitlement. But the inclusion of an entitlement is a necessary aspect of any ObamaCare-replacement plan that congressional Republicans put forth.  

When Trump said during the election that he refused “to let people die in the streets,” he was referring to the notion that millions have attained insurance — albeit bad insurance — under ObamaCare, and it would not be wise or acceptable to deprive impoverished citizens of the ability to have insurance. Trump was right, and tax credits are essentially Republicans accepting the new playing field post-ObamaCare, while imbuing the replacement with free-market principles.

Retaining two popular components of ObamaCare — permitting children under the age of 26 to remain on their parents’ plan and barring insurance companies from discriminating based on pre-existing conditions — are yet another populist infusion.  These provisions are wildly popular, with 85 percent of Americans in favor of the provision that allows 26 year-olds to remain on their parents’ plan and 69 percent in favor of the pre-existing conditions provision.

Rather than insisting on purist free-market principles, which would certainly conflict with the pre-existing conditions portion of ObamaCare, Republicans listened to the people and responded with a plan that incorporated the will of voters.

Republicans did not, however, sacrifice their conservative principles, as some hardliners will undoubtedly allege.  They got rid of the top-down individual and employer mandate, which forced the hands of private citizens to purchase or provide a product.  They eliminated almost all ObamaCare taxes.  They put money in the hands of the states, permitting them to operate as the laboratories of experimentation that they were intended to be, tailoring policies to the individual and pioneering innovative state-specific plans.  They bolstered Health Savings Accounts (HSAs), which will put the patient closer to healthcare decision-making and drive down rising healthcare costs.

In short, Republicans engaged in a discourse with the American people, listening to healthcare providers at the White House and hearing out citizens at town halls and forums.  In the end, they offered the American people a bargain — an offer to keep the portions of ObamaCare they like but erase the portions that they do not.  

Ultimately, Republicans addressed the maladies of ObamaCare — skyrocketing premiums increasing 25 percent on average, one-third of counties that offer just one insurance option, and 34 percent fewer doctors taking ObamaCare insurance — with free-market, capitalist, conservative principles.

Republicans offered a grand bargain, one that is emblematic of Trump’s brand of conservatism: remain loyal to conservative principles but be responsive to the needs of the American people and faithful in fulfilling your promises to them.

Kayleigh McEnany is a CNN political commentator who recently received her Juris Doctor from Harvard Law School. She graduated from Georgetown University's School of Foreign Service and also studied politics at Oxford University.

The views of contributors are their own and not the views of The Hill.