House Republicans have rolled out their highly anticipated bill to repeal and replace Obamacare this week, but a more obscure measure introduced by Rand Paul (R-KY) is gaining attention and should not escape notice.
Paul, who has positioned himself as a leading conservative critic of the forthcoming GOP proposal, has sponsored a measure that would leave untouched both Obamacare’s $1 trillion in taxes and its Medicaid expansion.
Stranger still, though Paul has characterized Republican plans for an age-related refundable tax credit as “Obamacare Lite,” his bill does the unthinkable: It retains the Obamacare income-related refundable tax credits.
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House Republicans on Monday unveiled their long-awaited legislation to repeal and replace ObamaCare.
The two measures dismantle the core aspects of ObamaCare, including its subsidies to help people buy coverage, its expansion of Medicaid, its taxes and its mandates for people to have insurance. (READ THE BILLS HERE AND HERE.)
In its place, Republicans would put in place a new system centered on a tax credit to help people buy insurance.
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How should the GOP move forward on Obamacare? First, they must honor their promise to repeal the law. Second, Republicans can’t make it worse; instead, they need to fix the problem. They can do this by: 1.) Beginning with the 2015 reconciliation bill repeal language, 2.) Also repealing the insurance regulations, and 3.) Focusing on areas of consensus among Republicans. Don’t try to replace one 2,000-page monstrosity with another. Instead, adopt common-sense specific reforms that will increase competition, drive down costs, expand choices and put patients back in charge of their health care.
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President Donald Trump, heading into a critical stretch of Republicans’ push to rewrite the Affordable Care Act, acknowledged Monday the effort would be complex and politically risky, but said he is determined to forge ahead because the ACA is a “disaster.”
“Nobody knew that health care could be so complicated,” Mr. Trump told a group of Republican governors after meeting with them and insurers—two groups whose cooperation could make or break the attempt to overturn the law some call Obamacare.
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In the populist era of the early 20th century, the people’s rage was directed not at political elites or government, as it is today, but at huge private monopolies, the “trusts.” Teddy Roosevelt’s trustbusting campaign helped establish competition as America’s fundamental mechanism for inducing private businesses to serve the public. If today’s populists are equally serious about protecting ordinary people, they should declare a similar war against monopoly in health-care markets.
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Obamacare has already failed, and it failed because the government violated several basic economic and free-market principles, resulting in devastating outcomes for those seeking coverage, people already covered, and taxpayers.
Under Obamacare, our most vulnerable citizens in Pennsylvania are paying more for health insurance with fewer choices. According to the Kaiser Family Foundation, individual premiums increased by more than 50% in Philadelphia this year. Deductibles for a family plan now exceed $6,000, and the choices continue to shrink.
Pennsylvania’s health care delivery system should encourage participation in the health-insurance market rather than mandating it as Obamacare did, offer the option of using open network, lower-cost, catastrophic plans supported by health savings accounts, and place much greater emphasis on prevention and addressing the causes of poor health.
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President Donald Trump’s initial budget outline signals he won’t immediately press forward with major entitlement reforms, but House Speaker Paul Ryan pointed to Republican efforts to repeal and replace Obamacare as proof that the GOP is unified on addressing the issue.
“Two entitlements are being reformed with repealing and replacing Obamacare, right now,” the Wisconsin Republican told reporters Tuesday at a weekly Capitol Hill news conference. “We are well on our way to repealing Obamacare.”
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Congressional Republicans have been struggling for months to resolve one of the most vexing problems in their tortuous effort to replace the Affordable Care Act: What to do about the generous federal funding for states that broadened their Medicaid programs under the law, while not shortchanging the 19 states that balked at expansion?
Now, as the House begins to hone details of its legislative proposal, a possible compromise has emerged. It would temporarily keep federal dollars flowing to cover almost the entire cost of the roughly 11 million Americans who have gained Medicaid coverage but would block that enhanced funding for any new participants.
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On Friday, Politico released a leaked version of draft budget reconciliation legislation circulating among House staff—a version of House Republicans’ Obamacare “repeal-and-replace” bill. The discussion draft is time-stamped on the afternoon of Friday February 10—and according to my sources has been changed in the two weeks since then—but represents a glimpse into where House leadership was headed going into the President’s Day recess.
A detailed summary of the bill is below, along with possible conservative concerns where applicable. Where provisions in the discussion draft were also included in the reconciliation bill passed by Congress early in 2016 (H.R. 3762, text available here), differences between the two versions, if any, are noted. In general, however, whereas the prior reconciliation bill sunset Obamacare’s entitlements after a two-year transition period, the discussion draft would sunset them at the end of calendar year 2019—nearly three years from now.
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The House could use regular order, not reconciliation, to pass a bill that not only fully repeals ObamaCare—returning control of the private market to the states—but simultaneously puts into effect at least the core components of reform while including grandfathering and other provisions to smooth the transition to lower-priced options on the free market.
Such a bill could easily pass the House, putting pressure on the Senate. Would Minority Leader Chuck Schumer allow proper consideration of much-needed health-care reform? And with all the evidence that ObamaCare has been a disaster and—untouched by Republicans—is quickly unraveling, would Democrats, 25 of whom are up for re-election next year, vote to defend the status quo?
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