House Republicans have tried more than three dozen times in the last three years to repeal all or part of the 2010 healthcare law, so it's hard to take them seriously now when they say they're trying to "improve" it.
In fact, when Republicans complain that Democrats won't negotiate about Obamacare, what they're really saying is that Democrats won't agree to kill it, delay the insurance reforms and subsidies until after yet another election, or undermine the law in a way that could send premiums for individual coverage through the roof.
The GOP's clear objective is to dismantle the act, not to improve it — and the single-minded focus on that goal is what has led to the partial government shutdown that began Tuesday. Democrats can hardly be blamed for refusing to bargain over how to sabotage the law before it fully takes effect.
It's too bad that Republicans aren't actually trying to make the law better, because the Patient Protection and Affordable Care Act is far from perfect. But the GOP's opposition has limited members of Congress to chipping away at the law, rescinding some provisions and cutting funds for others, rather than modifying its contents to fix problems as they emerge.
There are several things that members of Congress could be doing now to make it work better, if Republicans were interested. They could start by clearing up the uncertainties that have put some federal rules under a legal cloud — for example, by clarifying that Americans in every state can qualify for premium subsidies, not just those in the 16 states that are operating their own insurance-buying exchanges.
They could also look for ways to make the mandate to obtain coverage more effective. The financial penalties in the law are so low, many people would save money by paying the fine instead of signing up for coverage. That's particularly true of the younger, healthier people whose participation is key to holding down premiums. One step that would help on that front: allowing people over age 30 to sign up for less expensive plans with higher deductibles and out-of-pocket costs.
The Affordable Care Act rightly seeks to improve the U.S. healthcare system by advancing simultaneously on multiple fronts: shifting incentives to promote wellness instead of just curing illness, seeking more effective and efficient treatments, and extending coverage to more Americans. Because it's a huge and complex endeavor, lawmakers and the administration will have to make adjustments as it's implemented in order to get it right. Judging by what they've been proposing, though, Republicans aren't interested in making those adjustments — they just want the law to go away.