Thom Tillis's Obamacare Dilemma

The downside of opposition: the need to have a better idea

Not quite six months ago, I interviewed Thom Tillis in his legislative office in Raleigh for a piece that ran in the magazine’s November issue. I asked him about his views on health care reform and how he’d approach it as a candidate for U.S. Senate. His response:

Obamacare has focused on solving a broader-based problem than really exists. I think what we need to do is focus on the people who have a catastrophic illness, where they get into a situation where they simply have no money and they have no options. How do you manage that pool of high risk that exists out there without necessarily sweeping everybody into the pool? I’m opposed to a single-payer type of system. I’m opposed to a system where you're disintermediating employers and other insurers and people who can do a fine job with insurance.

Let’s recognize that there’s a significant number of the population that have insurance. So influencing this broader base that seems to be doing OK in the interests of addressing the percentage of the population that doesn’t have health care—seems to me that you’re really making the problem larger and more complex than it needs to be … There may need to be some blending, but I think just putting this into a large, complex federal program doesn’t make sense, because large, complex federal programs typically don’t do very well.

I thought about Tillis’s answer recently, when The Washington Post’s Greg Sargent pointed out the essential problem Republican candidates face in the midterm elections: The smarter ones, like Tillis, understand both the political value and practical impossibility of repealing Obamacare.

His answer from September inadvertently highlights the dilemma. How, indeed, do you manage a high-risk pool without broad-based enrollment in health insurance to prop it up? Does anyone have the answer to that one? Obamacare, though flawed and labyrinthine, is an effort to solve that problem (and countless others).

So far, the only formal GOP alternative is the plan U.S. Sens. Richard Burr, Orrin Hatch and Tom Coburn offered a month ago—the one that forces people with employer-based coverage to pay larger shares of the cost and replaces the individual mandate with the threat of never being able to buy health insurance again. Forbes referred to it as “A Big Tax Hike.” The senators unveiled their baby at a press conference and discovered it was stillborn.

So here’s Thom Tillis, no dummy. He has to walk a tightrope of dental floss. His campaign has made Kay Hagan’s support of Obamacare the center of its strategy. Yet the Burr-Hatch-Coburn plan has gained no real support among the Republican base. That leaves Tillis uttering noncommittal stall-ball rhetoric like this (video below): “We do need health care reform … Republicans do need to communicate that we agree that there are serious health care issues among the American people that we need to solve. But we need to do it in a way that’s prudent, that’s sustainable, and doesn’t put other programs like Medicare and Medicaid at risk.”

OK, fine. We’re waiting. At some point, Tillis—and the rest of the GOP—will have to pony up with a viable alternative to Obamacare. The more time passes, the more the electorate will surmise, accurately, that they don’t have one.