Do you think it is a bit strange that after 7 years, Republicans in Congress still don’t have a replacement plan for Obamacare? Or that they now tell us that developing one will take 3 or 4 more years. And of course, once they have a plan it will take state governments and insurance companies two or three more years to phase it in. So, we are looking at a decade’s delay. That’s if we are lucky.
Suppose the tables were turned. If Obamacare were a Republican reform and Democrats controlled Congress, how long would it take the Democrats to come up with a better plan? They’d do it in a heartbeat. They would do it by doing what Democrats are traditionally good at: putting ideology aside and finding solutions that make all the major stakeholders better off.
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With Republicans controlling both ends of Pennsylvania Avenue next year, they have a great, and rare, opportunity for reform. The question now is whether Donald Trump and a new congressional generation can enact center-right reform solutions, and the first proving ground will be ObamaCare. If Republicans don’t repeal the law immediately, the danger is that the natural inertia of Congress takes over and nothing changes. But the more time they put between repeal and replace, the more the danger will grow. Now’s the chance to show they can reform the entitlement state with solutions that improve the daily lives of Americans.
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In crafting an Obamacare replacement, Donald Trump and Republican congressional leaders will have to unite on complicated changes affecting the financial and physical well-being of millions of people. Republicans have “a really narrow path,” says Grace-Marie Turner. “They’ve got to deal with the politics of this, they’ve got to make sure they come up with good policy, and they also have to process challenges.” House Ways and Means Chairman Kevin Brady (R-TX) says of the challenge, “Unlike Obamacare, which ripped up the individual market, this will be done deliberately, in an appropriate timetable.”
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When President-elect Donald Trump chose Representative Tom Price of Georgia to be his health and human services secretary, the American Medical Association swiftly endorsed the selection of one of its own, an orthopedic surgeon who has championed the role of physicians throughout his legislative career.
Then the larger world of doctors and nurses weighed in on the beliefs and record of Mr. Price, a suburban Atlanta Republican — and the split among caregivers, especially doctors, quickly grew sharp.
“The A.M.A. does not speak for us,” says a petition signed by more than 5,000 doctors.
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House Speaker Paul Ryan, incoming Health and Human Services Secretary Tom Price and other top GOP leaders have kept up their barrage against the Affordable Care Act’s premium increases and reduced competition, even after their massively successful election last month.
“This law is hurting families in America,” Ryan said before Congress left Washington for the holidays.
“This law is canceling insurance plans people wanted, this law is giving people repeated double-digit premium increases, this law is raising deductibles so high it doesn’t even feel like you have insurance,” he said. “So you have to bring Obamacare relief as fast as we possibly can in 2017, and that is our plan.”
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Beginning in January, the Republican-controlled Congress, working with the incoming Trump administration, will have the opportunity to roll back the Affordable Care Act and replace it with a plan that is less driven by federal control and regulation. The starting point for this effort ought to be that everyone in the United States should have health insurance, protecting them against major medical expenses. To do so, the GOP should:
- Grandfather Coverage Provided by the ACA
- Accept and Clarify Medicaid’s Role as the Safety Net Health Insurance Program
- Impose Cost-Discipline and Generate Revenue with an Upper Limit on the Tax Preference for Employer-Paid Premiums
- Build an Effective Auto-Enrollment Program to Achieve Higher Levels of Coverage
In the midst of open enrollment for Obamacare, there is plenty of bad news for health law supporters, from skyrocketing premium rates to diminished insurer participation. Public opinion remains steadily opposed to the law.
After a fluid first few months in 2009 as the plan got underway in Congress, public opinion of Obamacare settled into a consistent trend in early 2010, with opposition outweighing support—often by a sizable margin.
Gallup’s tracking, for instance, shows that since the law took effect in 2013, a majority of Americans have consistently disapproved of it, ranging from a low of 48 percent in July 2015—just after the Supreme Court’s ruling upholding the law’s federal subsidies—to a high of 56 percent.
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Repealing Obamacare would free Americans to purchase more secure health insurance than either Obamacare or employers offer. Every day Congress waits, the problem of pre-existing conditions gets worse.
Congress should replace Obamacare as Mr. Trump pledged during the campaign.
Incredibly, some congressional Republicans are mulling a partial repeal—keeping the parts of Obamacare that supposedly protect sick patients, but instead make coverage worse and that are causing insurance markets to fall apart. There is even talk about keeping Obamacare’s billions of dollars in bailouts to insurance companies—including billions that a federal judge ruled unconstitutional—and using the money to replace Obamacare with Obamacare-lite.
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Health and Human Services Secretary-nominee Tom Price has a radical idea: Let Medicaid recipients choose their own health insurance plan just as millions of Americans do every year.
Both House Speaker Paul Ryan and Price want to replace Obamacare subsidies with refundable tax credits—which would essentially function like a federal subsidy—for people who do not have access to employer-provided health insurance, Medicare, Medicaid or VA coverage.
But under legislation introduced by Price in 2015 (see section 102), a person in a government-run program such as Medicaid could opt out and take the tax credit instead.
That’s exactly the right thing to do.
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