Republicans Attempt A Healthcare Do-Over
Corey Uhden, Politics Contributor
It’s only fitting that House Republicans unveiled their plan to “repeal and replace” the Affordable Care Act the same day President Trump quietly signed an executive order to revise the so-called travel ban that was interred by legal proceedings. March 6th, 2017 should be forever remembered as National Do-Over Day. The temporary travel ban do-over will likely mitigate the legal challenges that stymied Trump’s first executive order on travel and extreme vetting. The Republican health care plan doesn’t show as much promise for mitigating the damage wrought by the Affordable Care Act.
Despite electing the most theatrical president ever, Republicans are proving pretty awful at the theater of politics. They unveiled their plan, the American Health Care Act (AHCA), with a hashtag meant to invoke their original complaint about the 2,500 page monstrosity then-Speaker Nancy Pelosi infamously declared had to be passed “to find out what’s in it,” #ReadTheBill. Beyond that, though, there were a couple of tweets, on op-ed, and an exclusive interview on Special Report with Bret Baier between the two House committee chairmen responsible for shepherding its passage through the lower chamber, Rep. Kevin Brady of Texas and Rep. Greg Walden of Oregon. That was it for day one of the fight to repeal and replace Obamacare.
It’s a bill with few vocal supporters and many high-profile detractors. Sen. Rand Paul has already inspired his veritable army of social media warriors to decry the entire package as “Obamacare Lite.” The continuities are undeniable. Like Obamacare, the AHCA requires insurers to cover consumers with pre-existing conditions. It leaves the Department of Health and Human Services in charge of defining “essential health benefits” for insurers to cover. It caps out-of-pocket expenses and allows young adults to remain on their parents’ plans until they are 26. It also provides refundable tax credits for people to purchase qualified health insurance plans, but based on age and family size and not based solely on income as they were in the ACA’s exchanges. It would leave in place a Medicaid expansion until 2020 and after that gradually phase out matching funds for new enrollees as well as grant states the ability to craft more stringent requirements for their Medicaid compacts. It repeals the individual and employer mandates but requires a monthly 30% surcharge for a year of premiums on consumers that had allowed their coverage to lapse for 60 days or more. It would be quite difficult to imagine a better version of an Obamacare do-over.
Suffice to say that if this were President Obama and Speaker Pelosi’s original plan for health care reform, it might have attracted some Republican support, but they’d be taking a lot of heat for crossing a party with no real incentive to vote for something that is quite obviously an attempt to bureaucratically control one-fifth of the nation’s economy, its healthcare and insurance industry. Alas, this isn’t a pre-Obamacare world. The health insurance industry is struggling mightily under the imbalance of ACA-mandated outlays and ineffective incentives. Republicans would have the votes to repeal the ACA, but doing so could cause a cataclysmic collapse in American health insurance markets. Removing millions of customers would force insurers to raise premiums and deductibles on every household and business in the country. The subsidies have to be replaced and Republicans are hoping that the new refundable tax credits, along with doubling the amount available in health savings accounts, will encourage even more Americans to get covered. If they’re wrong, the political fallout from the Congressional Budget Office declaring that 30 million people could lose coverage would be the least of their worries.
In addition, it’s almost an article of faith among conservative policy experts that equalizing the tax benefits between individuals seeking health insurance and the employer-based, small group market is the key to expanding access to people who are not covered by their employer. The Republicans operated under an illusion of consensus on this reform, but the refundable tax credit proposal has been met with immediate scorn as a new entitlement that will only grow over time as Congress insists on chasing higher and higher healthcare costs with larger and larger tax credits. That is a real concern. How much is this new entitlement going to cost, and how is the federal government going to pay for it?
The AHCA has yet to be scored by the Congressional Budget Office at all. In the Frequently Asked Questions section of their website, House Republicans definitively declare only that “we’re still discussing details.” The bill is being marked up only two days after its introduction and the House is operating on a timetable that insists on passage before the Easter recess. There’s a possibility the bill will be debated in the House Budget Committee while members have no impartial analysis of its impact on the federal budget. Brady insists the bill will repeal all of the ACA’s tax provisions, so it is vitally important to ascertain how they plan to pay for any of it.
Brady, Ryan, and Walden are very clear that the bill was crafted to pass via the budget reconciliation process. They insist it comprises “phase 1” of an overall plan to build a better healthcare system than the one Democrats attempted to “reform” in 2010. It’s not clear they’ve succeeded in developing a framework that will pass with 51 Republican votes. As mentioned, Rand Paul, along with Sen. Mike Lee, is opposed to the current proposal and four Republicans representing states that expanded Medicaid under the ACA have said they will oppose passage of any bill that drastically alters the Medicaid funding formula. They may ultimately come around if Republicans provide a framework of flexibility for their states but with conservatives already sounding the alarm about the “largest entitlement ever proposed by a Republican administration,” the intraparty debate over how to expand access to affordable healthcare has only just begun.
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