The idea of turning more power over to the states has long been advocated by conservatives, but there are compelling reasons for liberals to get behind devolving power from the federal government.
When Congress passed the Affordable Care Act in 2010, it left many of the details to the discretion of the Department of Health and Human Services, giving vast powers to the secretary to determine everything from fast-food menu labeling requirements to when individuals could purchase insurance. During the Obama years, the administration used its regulatory discretion — pushing and arguably exceeding the limits of the law — to prop up the president’s signature legislative accomplishment as the program ran into implementation problems.
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Chen and Weinberg recently conducted an analysis of international health systems and concluded that single-payer advocates are substantially overstating the prevalence and success of such systems. While many other countries have universal health systems and feature more government control over individual health care decisions, almost none are actually single-payer. And all of them are wrestling with largely the same challenges Americans are, making different but equally difficult trade-offs on cost, quality and access.
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“Single-payer” is a broadly popular slogan that papers over intraparty disagreements and wrenching policy choices. A recent survey by Kaiser found that initial support for single-payer dropped by about a third when supporters were told of criticisms that it might increase their taxes, give the government “too much control” over health care or eliminate the ACA. Each of those critiques would probably be made prominently by Republican opponents of the policy.
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The Trump administration is giving health insurance companies more time to calculate price increases for 2018 because of uncertainty caused by the president’s threat to cut off crucial subsidies paid to insurers on behalf of millions of low-income people.
Federal health officials said the deadline for insurers to file their rate requests would be extended by nearly three weeks, to Sept. 5.
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Congressional Republicans moved on Tuesday to defuse President Trump’s threat to cut off critical payments to health insurancecompanies, maneuvering around the president toward bipartisan legislation to shore up insurance markets under the Affordable Care Act.
Senator Lamar Alexander of Tennessee, the influential chairman of the Senate Health, Education, Labor and Pensions Committee, announced that his panel would begin work in early September on legislation to “stabilize and strengthen the individual health insurance market” for 2018. He publicly urged Mr. Trump to continue making payments to health insurance companies to reimburse them for reducing the out-of-pocket medical expenses of low-income people.
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The Senate in the early hours of Friday morning rejected a new, scaled-down Republican plan to repeal parts of the Affordable Care Act, derailing the Republicans’ seven-year campaign to dismantle President Barack Obama’s signature health care law and dealing a huge political setback to President Trump.
Senator John McCain of Arizona, who just this week returned to the Senate after receiving a diagnosis of brain cancer, cast the decisive vote to defeat the proposal, joining two other Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, in opposing it.
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The Senate on Wednesday rejected a measure that would have repealed major parts of the Affordable Care Act but would not have provided a replacement, signaling that the “clean repeal” bill that conservatives have embraced cannot get through Congress.
The vote, 45-55, underscored the bind that Republican leaders have found themselves in. Seven Republicans voted against the measure — Senators Shelley Moore Capito of West Virginia, Susan Collins of Maine, Dean Heller of Nevada, John McCain of Arizona, Rob Portman of Ohio, Lamar Alexander of Tennessee and Lisa Murkowski of Alaska — showing that repealing the health law without an immediate replacement lacks crucial support among Republicans.
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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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But the core planks of the Senate Republicans’ health bill — the Better Care Reconciliation Act — borrow just as much from Democratic ideas as Obamacare borrowed from Republican ones.
The Senate bill’s plan to reform Medicaid by tying per-enrollee spending to medical inflation through 2025 and to consumer inflation thereafter was borrowed from a nearly identical 1995 proposal by President Bill Clinton. Indeed, the main difference between the Clinton proposal and the Republican one is that the Clinton proposal would have tied per-enrollee spending to growth in the gross domestic product. Historically, medical inflation has been higher than G.D.P. growth.
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According to Robert Wood Johnson Foundation data that looks at state markets where all insurers must sell plans that meet Obamacare standards, regardless of how they’re purchased, more than half of the 22 million people who buy their own insurance use Obamacare marketplaces, where most of them get a federal tax credit to help pay for coverage. The rest buy directly from an insurer or broker, and they do not get a tax credit. Supporters of the Affordable Care Act hoped the law would spur more competition among insurers across the country. But so far, the law has not delivered on that promise, especially in states that never had much competition. Even before Obamacare, there have always been two distinct markets: states that still have plenty of competition and states that rely heavily on one or two insurers. In 15 states, eight or more insurers offer Obamacare plans. They are mostly the same ones where no single insurer had a dominant share of the market in 2013, before the law was enacted. But the 19 states that currently have fewer than five carriers statewide are all ones where a single insurer had more than half of the overall market before Obamacare.
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