Our health-care system is broken. It was inefficient before Obamacare, and Obamacare’s Washington-knows-best-mandates made it many times worse. The American people have suffered as a result. We can’t return to the pre-Obamacare status quo, because Americans need more access to health care. But we also can’t leave the American people tied to a sinking Obamacare ship, forced to face higher annual premiums and fewer provider choices. We need relief based on clear principles: Government shouldn’t dictate our health-care choices, health care should be driven by market principles, and we must help those who truly need our help.
. . .
Trump administration officials have a lot of work ahead of them, but also a tremendous opportunity to make history. Returning the executive branch to its proper role under the Constitution will also spur Congress to enact reforms that make health care better, more affordable, and more secure.
Michael F. Cannon, Director of Health Policy at the Cato Institute, outlines 14 ways Trump-administration officials can restore the Constitution’s limits on executive power, provide relief to Americans suffering under Obamacare, and hasten repeal.
. . .
As the 115th Congress convenes and President-elect Trump prepares to take office tomorrow, our nation faces incredible challenges and opportunities. On health care in particular, the stakes couldn’t be higher, nor the path forward more clear. As leaders working on state-based policy solutions across the country, we have seen the impact of Obamacare on our communities up close. That’s why we’ve produced a report, being released today, on the need to unwind the law’s disastrous expansion of Medicaid.
Given the focus on the disastrous launch of the law’s insurance exchanges in 2013, many people don’t know that most of Obamacare’s coverage gains have come not through those exchanges, but through its new expansion of Medicaid to able-bodied, working-age adults.
. . .
Here are the priorities an Obamacare replace plan should have:
1. It should get 60 votes in the Senate.
2. It should repeal and replace in one go.
3. Cover at least as many people as Obamacare.
4. Don’t leave poor people out in the cold.
5. Fight provider cartels.
6. Enable technology-driven innovation.
7. Nudge people away from employer-provided insurance.
. . .
Republicans have made a great deal of progress toward broad agreement on a general policy approach over the past half-decade. The GOP has been preparing for the opportunity to enact conservative health care reform for years, and it now faces both a party electorate and a health care system that will not allow for endless indecision. It is too soon to know what the final product will look like, and whether a series of reconciliation bills or some uneasy combination of partisan and bipartisan measures will emerge. But it does seem likely that a year of intense action on health care is beginning.
. . .
Republicans have their best opportunity in a generation to enact a reform plan for health care that moves decisively toward a market-based approach, with far less reliance on federal regulation and control. A reform plan of this kind would represent a dramatic break from decades of policymaking and would be a major component of an effort to rein in the sprawling federal welfare state.
To succeed in this effort, however, House and Senate Republicans, as well as the incoming Trump administration, must dispense with wishful thinking. There is no plan for replacing the Affordable Care Act (ACA) that is without political controversy. Whatever they do will involve trade-offs, and in some cases they will be attacked by their political opponents for doing what is necessary but perhaps unpopular.
. . .
The GOP isn’t killing Obamacare. The program is already dead.
Andy Slavitt will step down as the government official overseeing Obamacare on January 20. He should be charged with leaving the scene of an accident. Obamacare’s individual markets are a twisted wreckage. Insurers are fleeing them, consumers are shunning them, and Democrats are looking for someone to blame.
In addition to devolving regulatory authority to the states, federal policymakers should consider providing them with resources to reform markets and subsidize coverage. Instead of writing suffocating rules and enlisting the Internal Revenue Service to distribute subsidies and exact penalties, the federal government should set states free to innovate and hold them accountable for results.
. . .
If Donald Trump and the Republican Congress have a mandate to do anything, it is to repeal Obamacare. The law is already cratering. Sick enrollees, former president Bill Clinton laments, are seeing “their premiums doubled and their coverage cut in half.” Even supportive economists admit the program is in a death spiral.
Repeal won’t be easy. But if Trump sets for Congress the same agenda he laid out during the campaign, he could become America’s greatest health-care reformer, all while cutting taxes more than Ronald Reagan and George W. Bush combined.
. . .
President-elect Trump said that he was open to keeping parts of Obamacare. The Wall Street Journal reports, “Mr. Trump said he favors keeping the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies.” He’s not the first Republican to advocate keeping these popular provisions of the law. Keeping the under-26 provision is pretty close to a consensus among Hill Republicans. It’s not the ideal policy, in my view. But it’s compatible with a much freer and better-functioning health-care market than we have now, and it’s worth accepting as part of legislation that enables that market.
. . .
Donald Trump hadn’t been president-elect for a week when he appeared to abandon his oft-repeated pledge to repeal Obamacare in its entirety. In interviews with the Wall Street Journal and 60 Minutes, Trump appeared to want to keep, or at least to be willing to accept, the Affordable Care Act’s centerpiece: it’s supposed prohibition on discrimination against health-insurance applicants with pre-existing conditions. Ramesh Ponnuru, my friend and a senior editor of these pages, says the downside of Trump’s triangulation is that retaining those provisions “makes it much, much harder to get rid of the individual mandate” — as if the mandate were the bigger problem. On the contrary, the pre-existing-conditions provisions are the centerpiece of Obamacare.
. . .