The Hunt for the Conservative Obamacare

Meet the Bobby Jindal-backed wonk who’s aiming to put the “replace” in “repeal and replace.”

Louisiana Governor Bobby Jindal wants a conservative alternative to the Affordable Care Act.
National Journal
Clara Ritger
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Clara Ritger
Dec. 30, 2013, 1 a.m.

Is there any­thing you think Obama­care does well?

For the first time in a long con­ver­sa­tion, the ques­tion leaves Chris Jac­obs si­lent. A minute goes by be­fore he speaks: “I think I want to pass.”

Jac­obs is the new policy dir­ect­or of the Bobby Jin­dal-foun­ded think tank Amer­ica Next, and that’s not the con­ver­sa­tion he’s in­ter­ested in hav­ing.

In­stead, Jac­obs — who comes to his new role by way of the Her­it­age Found­a­tion — re­peatedly em­phas­ized that his or­gan­iz­a­tion’s aim was to put for­ward “al­tern­at­ive, con­ser­vat­ive solu­tions” in health care, en­ergy, and edu­ca­tion. But Jac­obs wants Amer­ica Next to go bey­ond put­ting solu­tions for­ward: He wants his or­gan­iz­a­tion to be gen­er­at­ing the policies that con­ser­vat­ives en­deavor to put in­to prac­tice.

“The goal is not to cre­ate a bunch of pa­pers that sit on shelves some­place,” he said. “This is de­signed to be a series of ideas that the con­ser­vat­ive move­ment can really rally around.”

Such uni­fy­ing pro­pos­als have been dif­fi­cult to find for the con­ser­vat­ive move­ment. “Re­peal and Re­place” Obama­care has been a con­sist­ent man­tra among con­ser­vat­ives, but — in Con­gress, at least — it’s the “re­peal” por­tion that is get­ting the li­on’s share of at­ten­tion.

The move­ment is still look­ing for a “re­place” pro­pos­al, or set of pro­pos­als, to el­ev­ate in­to the pub­lic arena. Without that, Re­pub­lic­ans will con­tinu­ally face cri­ti­cism that their agenda is more anti-Obama than any­thing else.

Jac­obs wouldn’t say what those new ideas are, in part be­cause many are yet to be for­mu­lated, but he has an idea of where they’ll come from.

Jac­obs sees the states as the primary in­cub­at­ors of con­ser­vat­ive ideals. “Wash­ing­ton has been dys­func­tion­al for years,” he said. “In many cases, the solu­tions will come from the state­houses and the good con­ser­vat­ive ideas that are be­ing put for­ward and en­acted in states across the coun­try.”

Some of the con­ser­vat­ive thought lead­ers he looks to for health care solu­tions in­clude Jin­dal, Rep. Paul Ry­an of Wis­con­sin, Sen. Tom Coburn of Ok­lahoma, and Rep. Tom Price of Geor­gia.

As Jac­obs puts it, he’s “spent the last four or five years ar­tic­u­lat­ing the case against Obama­care,” and now it’s time to high­light ex­ist­ing al­tern­at­ives — in ad­di­tion to for­mu­lat­ing new ones — to push back against the pres­id­ent’s agenda.

Jac­obs is a wonk in every sense of the term. He gets ex­cited talk­ing about Medi­care Part D re­form, and he spent free time as a 21-year-old on the budget com­mit­tee at Amer­ic­an Uni­versity, his alma ma­ter. He teaches health policy at Amer­ic­an now, and re­mem­bers what life was like dur­ing the fall of 2009 when he juggled his col­loqui­um with his work on the Hill.

“I was in meet­ings in the Cap­it­ol talk­ing about the Re­pub­lic­an al­tern­at­ive to Obama­care and sit­ting there with pa­pers mark­ing up gram­mar,” Jac­obs said.

But what Jac­obs wants most is to see policy solu­tions — de­veloped at Amer­ica Next — put in­to ac­tion.

“It’s something that we really haven’t been able to do for the past, well, five years now, be­ing in the minor­ity,” Jac­obs said. “To put these policies in­to prac­tice would be very grat­i­fy­ing.”

Jac­obs will ex­pand his port­fo­lio at the or­gan­iz­a­tion to in­clude en­ergy and edu­ca­tion, but he re­mains most pas­sion­ate about health care.

“If you care about the fu­ture fisc­al policy of the coun­try, you have to care about health care,” Jac­obs said. “Con­ser­vat­ives some­times just want to talk about tax policy or budgets, but all of it comes back down to health care in some way, shape, or form.”

As one-sixth of the na­tion’s eco­nomy,  health care is “the one policy area that af­fects every­body,” Jac­obs says.

“Every­body has a health care story. Every­body has opin­ions on the health care sys­tem. It’s why [Obama­care] has been such a hot-but­ton is­sue for the past four or five years,” he said.

There are four reas­ons why the Obama­care fight is far from over, ac­cord­ing to Jac­obs.

“First of all, this is a bad law,” he said. “And second of all, the ad­min­is­tra­tion isn’t even fol­low­ing the law.”

Jac­obs cites the string of delays in por­tions of the Af­ford­able Care Act among his reas­ons why he be­lieves the ad­min­is­tra­tion only en­forces the law “when it’s polit­ic­ally con­veni­ent for them to do so.”

His third con­cern is that the people who will be without health in­sur­ance will out­num­ber those who gain it come Janu­ary, giv­en the can­cel­la­tion no­tices sent to mil­lions of Amer­ic­ans who then struggled to nav­ig­ate through Health­ un­til the ma­jor­ity of the site’s fixes were in place in Decem­ber.

Jac­obs hearkens back to fisc­al policy — the cost of provid­ing uni­ver­sal health in­sur­ance and premi­um tax as­sist­ance — for his fi­nal point.

The non­par­tis­an Con­gres­sion­al Budget Of­fice says the health in­sur­ance cov­er­age por­tions of the law will cost the gov­ern­ment $710 bil­lion between fisc­al 2014 and fisc­al 2019. CBO also says, however, that the law con­tains oth­er pro­vi­sions that will “re­duce de­fi­cits over the next 10 years and in the sub­sequent dec­ade.”

Jac­obs isn’t buy­ing it.

“There’s go­ing to have to be a day of reck­on­ing when it comes to this law, be­cause our fisc­al situ­ation was already un­sus­tain­able. The idea that this law is in­vi­ol­ate and will nev­er be re­pealed or changed is just not ac­cur­ate. It’s go­ing to have to be,” he said. “And, soon­er or later, Demo­crats are go­ing to fig­ure that out.”

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