Bipartisan legislation unveiled this week in the House would limit hospitals and doctors to charging health insurers local market prices for care that is outside a patient’s network, a measure intended to curb surprise medical bills. At a news conference last week, President Trump emphasized bipartisan support for a fix. The House Energy and Commerce Committee unveiled its “No Surprises Act” that would require patients be told which providers are out of their network and whether they could face additional charges. Lawmakers will be collecting feedback in the coming weeks to refine the bill.

The U.S. does not have a “free market” health care system. 90 percent of Americans have health insurance, nearly all of whom have their coverage heavily subsidized by the government. Part of the misconception stems from the fact that 159 million Americans receive health insurance through their employers. Private coverage is not the same thing as market-based coverage. Thanks to long-standing distortions in the tax code, few workers have the opportunity to choose their own coverage in a transparent market where prices and benefits are easy to understand. Ultimately, the most important way to make employer-sponsored coverage more affordable is to evolve away from the group model and toward a system of consumer-driven, individually purchased health insurance.

Emergency medical care is an exception to the general principle of market exchange, whereby services are voluntarily bought and sold, with sellers competing on price. Under federal law, hospitals are required to treat patients that arrive needing emergency medical treatment, regardless of their ability to pay—but allowed to subsequently charge whatever they wish. In recent years, medical providers have increasingly exploited this arrangement by threatening exorbitant charges for out-of-network emergency care in order to force insurers to agree to generous reimbursement terms across the board. Patients have frequently been caught in the crossfire and forced to pay large “surprise bills” for emergency care by hospitals or doctors who remain out of network.

The GOP must narrow the Democratic health-care advantage. Too many people are too ready to believe that whatever Democrats offer on that front is better for the country. The GOP’s message for 2020 should emphasize the party’s strengths: taxes, jobs, regulatory relief, defense, energy and judges. But winning will also require Republicans to improve on health care. Unless Republicans make their case confidently and forcefully, the health-care issue could cost them victory in 2020.

For years, Sen. Bernie Sanders (I-VT) has campaigned for what he calls “Medicare for All”—a proposal that would abolish private insurers and replace them with a “federally administered single-payer health care program” that would cover all forms of health care with “no more copays, no more deductibles,” and no premiums aside from substantially higher taxes. The irony of the proposal is that it looks nothing like the actual Medicare program that seniors use today. Indeed, the part of Medicare that is working best is Medicare Advantage, which deploys private insurers to provide high-quality, low-cost coverage to seniors. The best way to reform Medicare is to enact reforms that will further improve the quality and affordability of Medicare Advantage plans, and to learn from Medicare Advantage to improve the coverage that younger Americans can obtain.

The Trump Administration may be slowing down its push to replace the ACA, but several conservative groups are still pushing the Health Care Choices proposal. “We keep hearing that Republicans don’t have any ideas and it makes us a little crazy, because [we] worked for a year and a half to come up with a new generation of health reform,” said Grace-Marie Turner, president of the Galen Institute. “One thing we have learned is that the federal government is out of its element overseeing and regulating something as regional and personal as health care,” said Turner. “States have a much better understanding of their markets and their constituencies. . . . and can really influence how their state moves forward. Also, people are smarter and understand more than they did before that more regulations mean higher costs.” 

President Trump has tasked three Republican senators with coming up with a replacement for Obamacare if courts strike it down. It’s a prudent contingency plan. Republicans should, for that matter, advance their own health-care plan even if the lawsuit fails. They cannot prevent Democrats from attacking them over health care by abandoning the issue.Obamacare’s key innovation was not the subsidization of Americans’ health-insurance purchases, an enterprise in which the federal government had been engaged for decades, albeit on a somewhat smaller scale. It was the centralization of health-insurance regulation in Washington, D.C. It is that centralization, and accompanying curtailment of choice and raising of costs, that Republicans tasked with replacing Obamacare should now work to undo.

On Wednesday, conservative policy leaders met with reporters at the Heritage Foundation to discuss the framework for Republican health care reform. The policy experts admitted that Republicans start with a “credibility gap” on health care, but argued that limited government approaches will better achieve the goals of driving down costs, providing more options, and helping the most vulnerable obtain health insurance.

“There is a credibility gap,” Grace-Marie Turner, president of the Galen Institute, admitted to PJ Media in the briefing. “I think the reason conservatives are in that gap is because they spent so much time talking about these little levers that they would pull from a government perspective, and not enough time talking about goals.”

In order to bridge the “credibility gap,” Turner directly addressed the key goals of health care reform and explained how the Health Care Choices Proposal presented by the Health Policy Consensus Group would accomplish those goals.

President Trump proclaimed this week that Republicans will become “the party of health care” and promised that a replacement that will be well-received by voters. “If the Supreme Court rules that Obamacare is out, we’ll have a plan that is far better than Obamacare,” he told reporters Wednesday during an event in the Oval Office. White House aides said they are looking at expanding options, such as bridge plans, that are “free from Obamacare’s burdensome mandates.” Also in the mix is legislation from Sens. Bill Cassidy (R-LA) and Lindsey O. Graham (R-SC) that would provide grants to states to provide coverage.

Is there a health care deal that would meet the needs and solve the political problems of members of both parties in Congress?

It seems almost inconceivable. The only talk on the left at the moment is Medicare for all. On the right there is not much talk about any aspect of health care. But when pressed, Republicans would still like to abolish Obamacare. Neither party is going to get its wish any time soon.

Still, desperate times call for new thinking. As voters get tired of hearing promises that are never met and never will be met, politicians will feel increasing pressure to accomplish something.