For decades American conservatives have sought to restore meaning to the 10th Amendment, which recognizes the states’ right to manage their affairs free from Washington’s interference. Passing the Republican Senate’s health-care bill would represent historic progress toward that goal.
Governors and state legislatures ask Washington every year for the right to receive their Medicaid funds in the form of a block grant, which would give them autonomy to manage the spending as they see fit. The Senate bill, for the first time, would allow that.
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It’s not a stretch to say that ultimately, keeping Obamacare on the books will take us to a single-payer healthcare system.
Conversely, enactment of the Senate GOP healthcare legislation embraces a vision that empowers individuals and families to make their own healthcare decisions. It will move individuals and families away from government programs and toward private markets. While it doesn’t achieve all the policy goals that the free market movement would like, it takes a huge step in the right direction and puts the nation on a path toward a market-based, consumer-oriented healthcare system.
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You won’t hear this from the establishment media but the Senate’s ObamaCare repeal bill contains massive tax relief for middle class families.
When it was signed into law seven years ago, ObamaCare implemented a health care system with top-down, bureaucratic command and control. The government told you what insurance you must have. And what you cannot have.
ObamaCare suppressed individual choice, competition, and state flexibility, and imposed a long list of taxes on businesses and families.
Republican Senators now have the chance to repair this damage by passing the Better Care Reconciliation Act (BCRA).
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But the core planks of the Senate Republicans’ health bill — the Better Care Reconciliation Act — borrow just as much from Democratic ideas as Obamacare borrowed from Republican ones.
The Senate bill’s plan to reform Medicaid by tying per-enrollee spending to medical inflation through 2025 and to consumer inflation thereafter was borrowed from a nearly identical 1995 proposal by President Bill Clinton. Indeed, the main difference between the Clinton proposal and the Republican one is that the Clinton proposal would have tied per-enrollee spending to growth in the gross domestic product. Historically, medical inflation has been higher than G.D.P. growth.
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Since Senate Republicans released their healthcare reform bill early Thursday, the narrative from the media has been that this bill is a giant tax cut for “the rich.”
This narrative is false. ObamaCare imposed a long list of taxes that directly hit middle class families.
The Senate’s “Better Care Reconciliation Act” (BCRA) repeals these taxes and contains a total of $701 billion in tax reductions over the next decade.
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Experts don’t always agree, but eight of us (including Grace-Marie Turner) from right and left found common ground on key health reform recommendations. We agreed that states should be given greater authority to configure and redirect revenue streams from Medicaid, CHIP and private insurance; that the existing tax exclusion for employer-sponsored health benefits should have reasonable limits; and that states need new authority to simplify their insurance markets and develop fiscally sound and affordable coverage options for their most vulnerable citizens, providing more help to those who can least afford the premiums.
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The Congressional Budget Office says 15 million people will lose medical coverage next year if the Senate GOP’s health-care bill becomes law. That’s not quite accurate. CBO doesn’t believe that millions will “lose” their insurance in 2018. Instead, the agency thinks that millions will happily cancel their coverage—even those who get it for free. The reason: The Senate bill would repeal the Obamacare tax penalty on the uninsured, known as the individual mandate. If CBO is to be believed, 15 million people didn’t want health coverage in the first place. They enrolled only to keep the IRS off their backs.
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On Monday the Congressional Budget Office released its cost estimate of the Republican Senate Better Care Reconciliation Act. CBO calculated that the proposed bill would reduce the deficit by $321 billion over the next decade. That is welcome news.
Less welcome, however, was CBO’s conclusion that the Senate bill would result in an additional 15 million uninsured in 2018 due to a lack of penalties. By 2026, CBO reports 22 million more Americans would be uninsured, primarily due to lower Medicaid coverage.
No matter that the number of Americans on the Obamacare exchanges is shrinking due to higher prices and fewer companies offering coverage.
Dave Hoppe, former chief of staff to House Speaker Paul Ryan, asked me in an email, “If there are few insurance companies offering insurance through the exchanges in 10 years, how are people without insurance losing anything?”
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The Senate Republican health-care bill would not repeal and replace Obamacare. The federal government would remain the chief regulator of health insurance. No state would be allowed to experiment with different models for protecting people with pre-existing conditions. Federal policy would continue to push people away from inexpensive catastrophic coverage. The bill also seems unlikely to stabilize insurance markets, even though their current instability is one of the main Republican talking points for passing it. The legislation gets rid of the “individual mandate” — Obamacare’s fines for not buying insurance — but keeps the regulations that made the mandate necessary. The result is likely to be that healthy people leave the market and sick people face much higher premiums.
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The Senate health-care legislative draft — officially titled the Better Care Reconciliation Act of 2017 — will, if passed, represent the greatest policy achievement by a Republican Congress in generations.
For decades, free-market health-reform advocates have argued that the single best idea for improving U.S. health care is to maximize the number of Americans who can afford to buy health insurance for themselves, instead of having to depend on the government or their employer. The Senate bill transforms the American health insurance landscape in this direction.
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