The Republican platform seems to have taken its cue from Speaker Paul Ryan’s A Better Way, at least when it comes to health policy. Not surprisingly, health care did not get top billing in the 66 page document. The economy, jobs, and taxes led off, with the Affordable Care Act, Medicare, and Medicaid relegated to later chapters. Although there is not much text, those words are important.\
Significantly, the platform takes up Medicare and Medicaid in the chapter on government reform. The document points out that Medicare’s long-term debt is in the trillions, and does not shrink from recommending actions that could set the program on a fiscally sound path. That requires change that will not be welcomed by everyone, so the platform pushes off that change for a decade in the hope of not alienating the senior vote. Nonetheless, the Republican Party has now officially endorsed Ryan’s premium support plan that can promote competition and more efficient health care.
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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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The Obama administration’s continuing efforts to rewrite and re-interpret the legal requirements of the Affordable Care Act (ACA) hit a new roadblock in federal district court yesterday. Judge Rosemary M. Collyer ruled that advance payments to insurers of cost-sharing reduction (CSR) subsidies for certain lower-income enrollees in Obamacare’s health insurance exchanges were never appropriated by Congress. Oops. She therefore enjoined any further reimbursements until a valid appropriation is in place, but the judge also issued a stay of that injunction pending any appeal by the parties.
The decision in United States House of Representatives v. Sylvia Matthews Burwell, et al. is a big win for House Republicans, other Obamacare opponents, and the rule of law. It also signals at least the outer limits of the Obama administration’s repeated efforts to stretch implementation of the 2010 law far beyond legal norms and the plain meaning of the ACA’s statutory text.
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A new note from JPMorgan economist Jesse Edgerton looks at what is happening with Americans who are working part-time for “economic reasons” — or Americans involuntarily working part time. As you can see in the above chart — the red line — the numbers remains elevated despite big declines in the U-3 and U-6 jobless rates. Edgerton:
There has been little recent relationship between the number of “extra” part-time workers and the level of U3 unemployment, questioning the idea that driving U3 down further will reduce involuntary part-time employment. . . In a note last year, we pointed out that the shift strikingly coincided with the passage of the ACA, which included an employer mandate to provide health insurance to employees working 30 or more hours per week. . . passage of the ACA preceded a large and unprecedented shift from workers working more than 30 hours per week to just under 30 hours. We continue to believe that the ACA can explain a significant number of the “extra” involuntary part-time workers.
When pressed during last Thursday night’s campaign debate in Houston for details of his proposed plans for replacing Obamacare after it is repealed, presidential candidate Donald Trump (?-NY) once again sputtered out something about eliminating “those lines” that states draw in regulating health insurance. What that exactly means involves some Trump-Land-to- Policy-World translation, and a little primer on what’s usually understand and misunderstood in this area of health policy.
Trump appears to be borrowing some of the language behind a traditional conservative Republican health reform proposal, which involves facilitating competition in health coverage through the sale and purchase of insurance products across states. It’s sometimes referred to as interstate competition or competitive federalism, or even just “consumer choice.”
Most standard questions aimed at presidential candidates in recent years have sought affirmation or denial of standard propositions. For example: Do you favor repealing or extending ObamaCare? Would you ensure near-universal insurance coverage? Do we need more federal regulation or greater state-level discretion?
That or they try to generate advance signals about near-term tactics. For example: Should we increase or trim taxpayer subsidies? How much should price variation be limited or curtailed? Are coverage and care goals better achieved through regulatory mandates or market-like incentives?
However, this is getting well-worn and generic, if not a little hackneyed, for these questions tend to obscure more basic dividing lines between candidates, and how candidates are likely to think about health policy and frame any plans for future changes. Of course, our vast accumulation of laws, regulations, institutions, entrenched interests, vulnerabilities, and evidence-free assumptions constrain any sort of “blank sheet of paper” rethinking in this sphere of politics. But we might better predict how candidates will proceed if we ask them the following five questions…
Last week’s seven-candidate debate hosted by the Fox Business Network once again found much to discuss in terms of national security issues, immigration law enforcement, even a little economic policy, and, of course, the latest round of character attacks and counter-attacks. Still missing in action: at least the first subcutaneous probe of where the respective candidates stand on health policy issues.
Based on recent performance, it’s questionable whether health policy has attracted sufficient interest among the media and Republican primary voters to command more than a few seconds on the debate stage. But it’s not for lack of potential lines of inquiry.
Here are some questions to the candidates from Tom Miller of the American Enterprise Institute that still await new rounds of oversimplified, evasive, or (one might hope) thoughtful answers.
Instead of more federal regulation and subsidies, what U.S. health care needs is adoption of market principles, starting with broad empowerment of the patient-consumer. The proposals advanced in this volume would replace many counterproductive and outdated federal policies with practical, market-based reforms that aim to provide all Americans with access to high-quality health care at affordable prices.
Some observers might question the usefulness of ongoing policy discussion about health insurance coverage for pre-existing conditions. After all, as of January 2014, insurers are barred from excluding such conditions from their policies, even for short periods, by the Patient Protection and Affordable Care Act (ACA). Moreover, insurers are no longer allowed to charge higher-than-average premiums to consumers with higher-than-average expected health costs. In short, many would say the ACA has solved the problem, so there’s nothing more that needs to be discussed.
After months of internal debate, the House passed a budget-reconciliation bill last Friday taking aim at Obamacare, but it is far from assured that the bill, or even an amended version of it, will ever emerge from the Senate. Budget-reconciliation bills are powerful legislative vehicles because they cannot be filibustered in the Senate (it takes 60 votes to invoke cloture and close off debate on most bills). That means, in theory at least, that the Republican majority in the Senate should be able to pass a reconciliation bill and send it to the president for signature or veto without needing any Democratic support.