More than a decade ago I was a health policy analyst at the Heritage Foundation. While my knowledge of the weeds of that issue have (thankfully) faded with time, the general concepts and my principles have not. That’s why it’s so frustrating to watch the Republican Party so screw up the golden opportunity to rid the country of the failure that is Obamacare.
The first time the House of Representatives attempted to “repeal and replace” the abomination driving up health insurance premiums they fell flat on their faces. They weren’t repealing, they were tweaking, at best, and accepting the concept of federal involvement in the health insurance market at worst.
This time is no different.
What the new bill will do we can only guess since it hasn’t been completed yet. Still, without the ink even out of the printer cartridge yet to start to dry, the House Freedom Caucus has endorsed the bill.
What we do know about the new bill is it’s won’t be all that different from that last one. What was “Obamacare-lite” has been slightly changed to “Obamacare-optional.”
One of the major changes we’re being told about is how states can get waivers to opt out of some of the coverage regulations. So what? That which can be opted out of can be mandated by another administration. That’s not “repealing” Obamacare when you leave the structure in place.
A state that seeks and is granted a waiver can easily have that waiver rescinded later by a President Warren or Sanders, forcing them into back into the federal, which remains in this bill. That federal system will still be ruled by regulation, not law, and regulations can be written and reinterpreted. As we’ve seen in the case of immigration law, even laws don’t mean what is clearly printed on the page, so regulations don’t stand a chance.
This bill appears to simply deflect decision making authority to the states, many of whom supported Medicaid expansion and will certainly not act to repeal Obamacare’s mandates. In short, this is a shell game.
Most telling about whatever this new legislation ends up being is how quickly House leadership is hoping to pass it. It hasn’t been finalized and there’s already talk of a vote as early as the next few days. Is it too much to ask that a bill impacting one sixth of the US economy be given as much time to be evaluated as marijuana stays in your system? To answer no makes me think there is as much to hide in this bill as someone with pot on their breath has to hide in their Altoids tin.
There’s a simple solution, it’s right there in the first half of the Republican’s nearly decade long campaign promise – repeal.
If Republicans truly believe in the free market, as they repeat like it’s their mantra, repealing this monstrosity and getting the federal government out of managing the private health insurance industry is the best route. That would not grant states the right to seek a waiver, it would free the states to create their own system.
Further removing the federal government from the market by allowing states to band together in whatever configuration they choose would fulfill one of President Donald Trump’s campaign promises – to allow for the purchase of insurance across state lines.
States would be free to set up markets however they like. Some would go, as California is hinting it would like, toward a single-payer model. That would be a disaster, but it’s their disaster to make. Other states would work together to set up large markets with minimal mandates, allowing consumers to purchase as little or as much insurance as fits their needs.
As for preexisting conditions, states would be free to recreated high-risk pools, which have been very effective in offering coverage to people with high health care costs.
In other words, this would be an embrace of the concept of federalism. Given Democrats’ new found love of the idea of the independence of states and cities, maybe even some of them would get on board. Probably not.
But the party that claims to be the champion of federalism should.
If the failure of Obamacare has shown us anything it’s the folly of a one-size-fits-all anything being dictated to 330 million people by 536 people from Washington, D.C. But politicians are slow to learn, no matter which party they belong to.
A bad plan by the Democrats should not be replaced by a slightly less bad plan by Republicans that leaves the original bad plan’s basic structures in place. You only get one bite at the apple.
The health insurance industry is an immensely complicated thing, the average American won’t fully understand whatever Republicans ultimately come up with. Still, giving the American people, and more importantly their representatives, a few days to comprehend some of the impact isn’t too much to ask. Unless there are questions that you don’t want asked in the first place…like are we just replacing their bad law with ours?