One Step at a Time: How to Repeal and Replace Obamacare
This column by ACRU Senior Fellow and Policy Board member J. Kenneth Blackwell was published January 12, 2017 by CNS News.
Seven years after the tainted, party-line passage of Obamacare, Republicans are in position to repeal it. The GOP has pledged a speedy repeal, but remains divided over what to offer as a replacement.
Obamacare critics who imagine they must put together their own legislative plan numbering hundreds or thousands of pages are mistaken. Instead, they should build a comprehensive policy by passing a series of smaller, more digestible bills to deal with specific problems.
Obamacare was a failure from the start, built on the shameless lie that people could keep their health plans and doctors and that costs would go down. Of course, the entire scheme was based on forcing individuals immediately, and employees with company plans eventually, into new, federally-approved systems.
The government would deny coverage it viewed as inappropriate, mandate benefits patients didn’t want, limit doctor choice for most everyone, and shift costs from the old to the young. Never mind if you were forced to pay more for less, you had to buy government-approved insurance or pay a penalty. To soften the economic blow taxpayers were forced to subsidize patients and providers alike. No surprise, the insurance and pharmaceutical lobbies liked Obamacare and contributed millions of dollars to help push it through Congress.
The law relied on expanding Medicaid, a welfare program, putting federal and state budgets simultaneously at risk. Medicaid originally was created to cover the poor and never delivered good care. Now Medicaid covers people who aren’t poor and still doesn’t deliver good care.
Of course, Obamacare didn’t work out as expected —- by the administration, that is. Premiums skyrocketed for policies people didn’t like. More sick than healthy people signed up, causing insurance companies big losses. Some insurers dropped out of the market entirely; others came to the federal government with hands extended. Patients found they had fewer choices even as they paid more. And the cycle continued.
The American people don’t like it. Congress should repeal it.
However, simply returning to the previous system isn’t a good solution, since it was flawed. What the GOP should do now is what the Obama administration should have done then: address specific problems with specific reforms. Rather than come up with GOPcare or Trumpcare, Republicans should simply adopt common sense changes which result in better health care.
For instance, Congress should protect our most critical safety net program, Medicaid, by block granting it to the states. The 1996 welfare reform applied this principle to the federal cash assistance program, AFDC, and literally broke the inter-generational cycle of poverty for millions of Americans. Block granting Medicaid would give states the ability to prioritize health care spending on their most vulnerable citizens. Permitting governors to design their own quality, cost-effective medical care delivery systems would benefit needy patients and taxpayers alike.
Insurers should be allowed to sell policies across the nation, making health insurance more competitive. Congress should override anti-competitive state mandates, which raise costs and reduce access.
Health insurance should be portable, which requires changing the tax treatment of health insurance. One possibility would be to shift the tax deduction from employers to employees. There are others, like restoring the availability of Health Savings Accounts.
Everyone agrees that people with preexisting conditions and chronic illnesses need access to affordable care —- which is actually affordable. The federal government should promote state high-risk pools as well as private charitable care.
Medicare patients deserve greater choice. Beneficiaries liked the Medicare + Choice program, which Obamacare unfortunately restricted. The needs of seniors are varied; so should be their health coverage options.
These and other reform proposals could be enacted separately. But taken together, they would offer a serious, patient-friendly alternative to what we now have. Congress could begin working on these reforms even before repealing Obamacare.
At the same time, Washington policymakers on both ends of Pennsylvania Avenue should coordinate with the states on how the federal government can make it easier for states to improve medical care. As with Medicaid, states should be held accountable while being given more freedom to design policies best tailored to meet their citizens’ needs.
On January 20 eight years of irresponsible, liberal social engineering will come to an end. Republicans need to be prepared to govern. They will fill the White House, dominate Congress, and control most state governments.
It then will be imperative for conservatives to prove that they can propose as well as oppose. Eight years of resistance blocked much that was bad. Now is the time to redress the damage that occurred —- starting with health care.
Republicans don’t have to have all of the answers. But they do have to show that they are committed to finding serious solutions to the many problems before us. It’s time to do that now.