How do we fix health care? The conservative policy world has offered a number of ideas, but elected Republicans have failed to coalesce around any particular strategy. J.D. Vance argues that this is because they’re unable to accept that the government must play a role in paying to solve this problem. This is where the Republican Party hits an ideological barrier that it simply must power through before meaningful reform can happen. Yes, solving problems can be expensive, and yes, that money always comes from taxpayers. Devising a vision is impossible when we refuse to accept that the government bears some financial responsibility in solving a problem it helped create.
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Senate Republicans, scrambling to win support for their health-care bill, pushed a measure Thursday that they said could ease the impact of the bill’s Medicaid cuts on low-income people.
Advocating for the new direction is a little-known health official who is now at the center of the health-care fight: Seema Verma, head of the Centers for Medicare and Medicaid Services, which oversees the two federal medical programs.
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It is a sign of Republican desperation that some think their best hope is to repeal ObamaCare and then pray something comes together in the next two years to replace it. President Trump even seems to expect that Democrats will help. Good luck with that.
Still, the repeal-only maneuver might provoke a fresh start, perhaps with a new bill drafted by some ad hoc group of legislators. Maybe failing to pass anything now will prompt wavering Republican senators to start supporting incremental, if imperfect, progress. A defeat of repeal on a procedural motion to take up the bill could cause Congress to drop health care now but return to it later, after Republicans make progress on tax reform, infrastructure, the debt ceiling and the budget.
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President Trump now suggests he may just let Obamacare collapse and blame Democrats since they did nothing to solve the problem. Grace-Marie Turner, President of the Galen Institute, said that strategy won’t work. “They are going to be blamed for the millions of people that would lose coverage if nothing is done because these exchanges are failing, insurance companies are signing up to provide coverage next year because they are losing so much money providing so-called insurance under Obamacare rules that don’t work,” she said. “Republicans own it. How can you have the White House and both houses of Congress and say that you don’t own this problem?” Turner asked.
But Turner is also slamming Democrats for asserting that premiums and deductibles are skyrocketing because Republican promises to repeal Obamacare are creating uncertainty among insurers. “That is just so completely beyond the realm of reality,” she said. “The reason that costs are going up under Obamacare is because of the flawed structure of the bill that, for one thing, encourages people to wait until they’re sick to sign up for coverage and that provides all sorts of opportunities for people to drop coverage and game the system.”
“Washington-centralized solutions are not the answer, whether Republicans are developing them or Democrats are developing them,” Turner said.
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Republicans seem to be able to achieve near-unity on ending the individual mandate, allowing insurers to offer discounts for younger people, protecting taxpayers from having to subsidize abortion coverage, and giving states some freedom to relax regulations. They should work for legislation that achieves these goals and includes as much Medicaid reform as 50 senators are prepared to tolerate. Republicans should not claim that such legislation would repeal and replace Obamacare, since it would not, and should make it clear that additional legislation will be needed in the future.
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Senate Republicans killed their own health-care bill on Monday evening. This self-inflicted fiasco is one of the great political failures in recent U.S. history, and the damage will echo for years. This wasn’t the inevitable result of some tide of progressive history, but choices made by individuals to put their narrow political and ideological preferences ahead of practical legislative progress. The “ObamaCare Republicans” come from both the conservative and moderate wings, but all of these Senators campaigned for nearly a decade on repealing and replacing ObamaCare. Now they finally have a President willing to sign literally any bill that lands on his desk, but in the clutch they choked. The ObamaCare Republicans ran on fiscal discipline but they rejected the best chance for entitlement reform in a generation.
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The Trump administration and Republicans in Congress find themselves in a position there never wanted to be in: heading into the August recess having failed to repeal and replace the Affordable Care Act (ACA), and also without any significant legislative accomplishments since the November 2016 election.
Before charting a new course, the GOP needs to understand how they drove themselves into this political ditch.
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Medicaid has become one of the most hotly debated issues in health reform. Almost all agree that reform is badly needed. In Congress, it has become a numbers game about millions of people and billions of dollars. One side decries the poor health outcomes that will derive from people losing coverage; the other argues that Medicaid desperately needs reform, not only to serve today’s recipients but also to effect solvency for future generations. Many are being told that empowering the federal government further is the way forward; conversely states, both red and blue, feel they can better serve their citizens if they were given more flexibility in managing Medicaid. How Medicaid is reformed is critical to the future of health care reform because it will form the template for the design of Medicare and private insurance going forward.
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The United States is facing another crisis in organizing its health care system. It is clear that the private exchanges concocted under the Obama administration are failing at a record rate for the simple reason that they violate all known sound principles of insurance. The planners who put these programs together unwisely thought that universal coverage would overcome the standard insurance problems of adverse selection and moral hazard.
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Rolling back ObamaCare’s Medicaid expansion has become the focal point of the health-care debate, and rightly so. Without fundamental change, Medicaid—expanded or not—will push state budgets to the brink even as it fails to help the most financially vulnerable Americans.
Consider Oklahoma, our home state. Despite intense lobbying by hospital corporations, the state Legislature stood strong and refused the Medicaid expansion. But the Medicaid rolls increased anyway, and at a dramatic cost to priorities like education, public safety and transportation.
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