Interestingly, while trying to craft legislation that would appeal to Republican moderates in the Senate, Cassidy and Graham have created a plan that is in some ways more conservative than the earlier House and Senate repeal-and-replace bills. The Cassidy-Graham bill is comparatively simple and straightforward. It lets states run their insurance markets as they see fit. This is a welcome return to federalist principles that the GOP had forgotten when crafting their earlier ObamaCare replacement bills.
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A crucial GOP senator says that after weeks of effort, there’s not enough agreement among lawmakers to advance a small package of bipartisan changes that would stabilize Obamacare’s health insurance markets. “We have worked hard and in good faith, but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted,” said Senator Lamar Alexander, the Tennessee Republican who leads the Health, Education, Labor and Pensions committee.
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The Centers for Medicare and Medicaid Services has a powerful tool for improving quality and reducing costs: the Center for Medicare and Medicaid Innovation. Congress created the Innovation Center in 2010 to test new approaches or “models” to pay for and deliver health care. The complexity of many of the current models might have encouraged consolidation within the health care system, leading to fewer choices for patients. The Trump administration is analyzing all Innovation Center models to determine what is working and should continue, and what isn’t and shouldn’t. Strengthening Medicare and Medicaid will require health care providers to compete for patients in a free and dynamic market, creating incentives to increase quality and reduce costs.
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It’s worth reading the Graham-Cassidy bill. It would repeal the individual and employer mandates of the Affordable Care Act, impose per capita caps on Medicaid, increase contributions to health-savings accounts, allow states to waive regulations on private insurance providers, and provide those states with block grants so they can design their own health-care systems.
If the bill became law, it would therefore be a genuine federalist triumph. A large portion of the federal money now set to fund the Medicaid expansion and subsidies of the Affordable Care Act would be instead distributed to individual states. Each state would have the freedom and means to develop its own health-care system. Reasonable people disagree over how best to design a health-care system, and under Graham-Cassidy, their ideas could be tested without causing a nationwide catastrophe and the disruption of a vital service.
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Lower than expected enrollment, rising premiums, and declining issuer participation have led to an increased focus by state and federal policymakers on stabilizing the individual health insurance market. Legislative proposals aimed at addressing these concerns are currently being discussed. Assuming the package of proposals were approved by Congress and issuers were permitted and willing to refile rates for the 2018 plan year, a combination of these policies may lead to the reduction of individual market premiums—as compared to current law–by 13% to 17% for 2018, driven primarily by the reinsurance program as well as the continued Health Insurance Tax moratorium.
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Chen and Weinberg recently conducted an analysis of international health systems and concluded that single-payer advocates are substantially overstating the prevalence and success of such systems. While many other countries have universal health systems and feature more government control over individual health care decisions, almost none are actually single-payer. And all of them are wrestling with largely the same challenges Americans are, making different but equally difficult trade-offs on cost, quality and access.
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Sen. Patty Murray has agreed to a key demand of Sen. Lamar Alexander, chairman of the Health, Education, Labor and Pensions Committee, which could potentially move bipartisan health care talks forward. Murray has agreed to “significant state flexibility” in order to reach an agreement, per a senior Democratic aide.
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Senate Republicans’ last-gasp Obamacare repeal effort is gaining steam, with key senators who tanked the last push in July signaling new openness to the latest attempt and GOP leaders growing increasingly bullish.
While the proposal written by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) remains short of 50 votes, it also has just one hard “no” vote, from Kentucky Sen. Rand Paul, and another expected “no” in Sen. Susan Collins of Maine. Three “no” votes would kill the bill, but in an encouraging sign for repeal proponents, no one is stepping forward yet to deliver that final nail.
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Unless Republicans can agree by Sept. 30, they won’t be able to pass a bill without 60 Senate votes. Here’s a wild idea: Instead of repealing ObamaCare, make it unconstitutional. Recall how the Supreme Court split when it upheld ObamaCare in 2012. What broke the tie was a novel opinion by Chief Justice John Roberts, who upheld the law’s individual mandate by declaring it a tax. The GOP can take advantage of that premise and pass a two-page bill clarifying that Congress did not intend to use its taxing power to enforce the individual mandate and disavows the same going forward. Congress could state that it intends ObamaCare to contain no severability provision—meaning that, as the four dissenting justices agreed in 2012, the entire law must fall if the mandate is unconstitutional.
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Kaiser’s tracking poll in July found 53 percent in favor of having all Americans get their health insurance from the government; 43 percent were against that. Opposition climbed to 60 percent when people were asked to consider that such a plan would call for higher taxes for many.
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