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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Major bipartisan accomplishments in federal policy feel like a rarity these days. But it was just over 20 years ago that the parties came together to pass significant, positive reforms to our nation’s cash assistance program for families in poverty. The 1996 welfare-reform law, passed by a Republican Congress and signed by President Bill Clinton, significantly strengthened work requirements in a new program, now known as Temporary Assistance for Needy Families (TANF). In the years following the law’s enactment, child-poverty rates dropped significantly and employment among poor mothers increased, while teen pregnancy and abortion rates continued to fall. Policies that encouraged work succeeded in achieving the intended, positive result: fewer Americans in poverty and more Americans providing for themselves.
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The individual market shrank by 15% between March 2016 and March 2017, including a 25% decline among unsubsidized policyholders. The individual market is not “sound.” Because of rising premiums, millions of people who are not receiving subsidies can no longer afford to buy individual policies, and millions more may forfeit their policies in the next round of rate hikes.
Relinquishing at least some regulatory authority to the states might produce more functional markets where insurers can offer consumers the coverage they want at a price they can afford.
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“Repeal and replace” made Republicans electoral Supermen, but “pre-existing conditions” were their kryptonite. Senate Republicans played out the final scene of their legislative tragedy in the early hours of Friday morning when they formally laid to rest their seven-year effort to repeal the law. Through four election cycles, Obamacare’s rising premiums, burdensome cost-sharing, narrow networks, and plan cancellations helped fuel GOP electoral victories at every level of government. The failure suggests why the political consequences are likely to be deep and long-lasting.
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The GOP cannot simply “move on” and give up on health care. Health care is the biggest driver of our debt and deficit, the biggest driver of growth in government, and one of the biggest drivers of economic insecurity for those in the middle class and below. Take some time to reflect, yes. Come up with a better strategy, yes. But to give up on health-care reform is to give up on everything conservatives stand for.
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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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After all this time, it increasingly appears impossible to get 50 Republican senators to agree on legislation to replace Obamacare. Last night brought genuinely shocking news as two GOP senators, who up until now hadn’t appeared to be likely “no” votes, announced their opposition: Jerry Moran of Kansas and Mike Lee of Utah.
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Congressional Republicans should stop calling their health-care bills a repeal of Obamacare. The House bill is not one — it keeps Obamacare’s regulatory heart — and the Senate bill is even less of one now that it has been amended to keep some of Obamacare’s most economically destructive tax increases. And because the bill is not a real repeal, people will face some combination of higher premiums, co-payments, and deductibles than they otherwise would. Moderate Republicans, who said for years that they wanted to repeal Obamacare but apparently never thought through what repeal would entail, are mostly to blame for these disappointing facts. Republicans have failed to make good on their promises.
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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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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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