Progressive supporters of health reform wanted a public plan option to compete with private insurers offering insurance in the state and federal health exchanges. To draw support from progressives, proponents of the Patient Protection and Affordable Care Act (ACA) created a type of nonprofit health insurance cooperative that would compete with established health insurers. Consumer Operated and Oriented Plans, or health insurance COOPs, as they are commonly known, were a political compromise for those who supported allowing non-seniors to buy their way into Medicare or a similar public program.
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More than six years of efforts by Republican and other right-of-center opponents to repeal, replace, or substantially reshape Obamacare have fallen short.
The strategic options ahead for Obamacare critics on the right are:
- Rinse and repeat: more of the same
- Gamble on a more ambitious long-shot strategy
- Adapt tactically in the near term, to minimize future damage
House Republicans released their latest plan – “A Better Way” – to repeal and replace the Affordable Care Act last month. It blends all three of the strategies above, but its lite brew for reform remarkably manages to be both too cautious and too unrealistic all at once.
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This week, President Obama published an President Obama published an article in the Journal of the American Medical Association that is likely to be his last and most comprehensive defense of the Affordable Care Act — a.k.a. Obamacare — while in office. Not surprisingly, it’s a rather one-sided accounting.
The president says the law has reduced the number of uninsured Americans, slowed the pace of rising health-care costs, and improved access to high-quality health care for millions of Americans. He also says more progress would have been made if not for the “hyperpartisanship” infecting Washington. He betrays no hint of self-awareness that perhaps his own conduct and statements, and the manner in which the law was pushed through Congress and enacted, might have been causes of the deep divisions in health-care policy that have persisted throughout his presidency.
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The release of the House GOP health-care plan last month was a milestone event in the long-running debate over the future of health care in the United States. Republican leaders had been promising to repeal and replace the Affordable Care Act — a.k.a. Obamacare — since it was enacted in 2010. But this is the first time that GOP leaders in Congress have presented a plan that could accurately be described as “the Republican alternative.” If the GOP is in a position in Congress to take up health-care legislation in 2017 (or later), this plan will almost certainly be the starting point.
House Speaker Paul Ryan deserves the credit for making this happen. He announced last fall after taking over the speakership that he wanted the GOP to offer a proactive agenda in order to give voters a clear idea of what Republicans would do if given the opportunity to govern. He followed through on that promise by getting his House colleagues to support plans for top-to-bottom reform of most key responsibilities of the federal government.
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Health insurance premiums have risen rapidly in the three years since the launch of ObamaCare’s exchanges, despite the law’s multibillion-dollar efforts to keep a lid on them. ObamaCare created three mechanisms for bailing out insurers if they lost too much money through the exchanges — the so-called risk corridor, risk adjustment and reinsurance programs. The hope was that the prospect of federal cash to cover potential losses would yield lower premiums.
Cash has indeed been flowing from the federal Treasury — but it hasn’t done much good. According to a new report from the Mercatus Center at George Mason University, the Obama administration has given health insurers 40% more in bailout funds under the reinsurance program than originally planned. Yet premiums still rose by as much as 50% in some parts of the country.
Things will only grow worse. Next year, the reinsurance program will end. Insurers will likely respond by hiking premiums even more or withdrawing from the exchanges. Many have already opted for the latter course because of significant losses.
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The health care law President Obama signed six years ago was supposed to fix the individual insurance market with enlightened rules and regulations. Instead, ObamaCare is destroying this market. Just look at what’s happening to Blue Cross Blue Shield.
If any insurer could cope with ObamaCare, it should have been Blue Cross Blue Shield.
Blue Cross companies came into the ObamaCare exchanges with decades of experience writing individual policies. Most of them are non-profits, which gives them an automatic leg up on the competition. And their plans captured the largest share of the exchange markets across the country.
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For six years, it has been abundantly clear that Americans want Obamacare to be repealed—but only if a well-conceived conservative alternative is positioned to take its place. That’s why the recent release of the House GOP health care plan is a big deal. The new plan would of course repeal Obamacare. But it would also fix what the federal government had already broken even before the law was passed and made things so much worse.
The proposal pairs an Obamacare alternative with Medicaid reforms and the crucial Medicare reforms (amounting to a kind of “Medicare Advantage Plus”) that Speaker Paul Ryan and House Republicans have long championed. As Ryan put it after the proposal’s release, “The way I see it, if we don’t like the direction the country is going in—and we do not—then we have an obligation to offer an alternative….And that’s what this is.” He called the plan not merely “a difference is policy” but “a difference in philosophy.”
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The healthcare plan released today by House Speaker Paul Ryan offers a modern refashioning of the consumer empowerment that has formed the foundation of conservative policymaking. This turns principally on an expansion of health savings accounts and other elements that reshape the healthcare benefit into a defined contribution of money that consumers can own and control, and that becomes more portable. The idea is that people can own their own coverage and take it with them, even as they move around and between different insurance pools and jobs.
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Today, after years of hearings and speeches and debates, the Paul Ryan-led House of Representatives has done something it has not done before: it has released a comprehensive, 37-page proposal to reform nearly every federal health care program, including Medicare, Medicaid, and Obamacare. No proposal is perfect—and we’ll get to the Ryan plan’s imperfections—but, all in all, we would have a far better health care system with the Ryan plan than we do today.
The first thing to know about the Ryan-led plan — part of a group of proposals called “A Better Way” — is that it’s not a bill written in legislative language. Nor is it a plan that has been endorsed by every House Republican.
Instead, it’s a 37-page white paper which describes, in a fair amount of detail, a kind of “conversation starter” that House GOP leadership hopes to have with its rank-and-file members, and with the public, in order to consolidate support around a more market-based approach to health reform.
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The looming collapse of the Obamacare exchanges is prompting calls for even more government involvement in healthcare — even a single-payer system.
It takes a special kind of reasoning to respond to the spectacular failure of government that is Obamacare by calling for, well, even more government.
Obamacare is faltering. No matter who wins in November, the next president will face a genuine crisis of the current president’s making.
And it defies logic to attempt to correct this entirely predictable failure of government with “fixes” that give the federal government even more control over Americans’ healthcare.
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