Progressives are lining up to assail the GOP’s health-care bill, though many on the political right seem to be even more unhappy. A little internal division is inevitable in any reform campaign worth fighting for, but the alternative strategies these conservative critics are suggesting are less than persuasive.
To repeal and replace ObamaCare, Republicans must manage a mix of policy, political and procedural variables that are more complicated than usual. Compromises are necessary to earn 218 votes in the House and then a simple majority among the 52-member Senate GOP conference under the budget reconciliation process, which can bypass the filibuster but limits the scope of what the bill can contain. Call it the art of the deal.
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‘ObamaCare is collapsing,” President Trump said during his address to Congress last week, “and we must act decisively to protect all Americans.” House Republicans have heard the president’s message loud and clear. On Monday night the congressional committees we lead released the American Health Care Act, which will rescue those hurt by ObamaCare’s failures and lay the groundwork for a patient-centered health-care system.
Our fiscally responsible plan will lower costs for patients and begin returning control from Washington back to the states, so that they can tailor their health-care systems to their unique communities. The bill will improve access to care and restore the free market, increasing innovation, competition and choice.
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President Donald Trump, heading into a critical stretch of Republicans’ push to rewrite the Affordable Care Act, acknowledged Monday the effort would be complex and politically risky, but said he is determined to forge ahead because the ACA is a “disaster.”
“Nobody knew that health care could be so complicated,” Mr. Trump told a group of Republican governors after meeting with them and insurers—two groups whose cooperation could make or break the attempt to overturn the law some call Obamacare.
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In the populist era of the early 20th century, the people’s rage was directed not at political elites or government, as it is today, but at huge private monopolies, the “trusts.” Teddy Roosevelt’s trustbusting campaign helped establish competition as America’s fundamental mechanism for inducing private businesses to serve the public. If today’s populists are equally serious about protecting ordinary people, they should declare a similar war against monopoly in health-care markets.
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Republicans are nervous about repealing ObamaCare’s supposed ban on discrimination against patients with pre-existing conditions. But a new study by Harvard and the University of Texas-Austin finds those rules penalize high-quality coverage for the sick, reward insurers who slash coverage for the sick, and leave patients unable to obtain adequate insurance.
The researchers estimate a patient with multiple sclerosis, for example, might file $61,000 in claims. ObamaCare’s rules let MS patients buy coverage for far less, forcing insurers to take a loss on every MS patient. That creates “an incentive to avoid enrolling people who are in worse health” by making policies “unattractive to people with expensive health conditions,” the Kaiser Family Foundation explains.
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The House could use regular order, not reconciliation, to pass a bill that not only fully repeals ObamaCare—returning control of the private market to the states—but simultaneously puts into effect at least the core components of reform while including grandfathering and other provisions to smooth the transition to lower-priced options on the free market.
Such a bill could easily pass the House, putting pressure on the Senate. Would Minority Leader Chuck Schumer allow proper consideration of much-needed health-care reform? And with all the evidence that ObamaCare has been a disaster and—untouched by Republicans—is quickly unraveling, would Democrats, 25 of whom are up for re-election next year, vote to defend the status quo?
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Republicans are getting battered at town halls on ObamaCare, with constituents—or least protestors—yelling about the benefits they’ll lose if the entitlement is repealed. But maybe the better measure of public sentiment is the choices that the people who are subject to ObamaCare have made in practice. Consider the remarkable persistence of health insurance plans that aren’t in compliance with the ACA’s rules and mandates. These “grandfathered” and “grandmothered” plans aren’t obligated to meet ObamaCare’s very high “essential benefits” floor, nor are they required to obey price controls that limit how much premiums can differ based on pre-existing medical conditions. These regulatory differences have thus set up an instructive market test about the need for ObamaCare’s mandates. 8.1 million people chose to remain in their existing plans instead of purchase ACA coverage.
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Every day brings a new story about Republicans in disarray, the “mirage” of the GOP’s reform and the impossibility of change. The reality is that Congress is on schedule, progress is underway, and the many potential problems are avoidable.
Behind the scenes, members and staff are being briefed on options and the House will release a consensus proposal after the Presidents Day recess. The details matter and are under discussion, but the outlines are emerging. Congress will use the reconciliation budget maneuver to bypass the Senate filibuster and pass a version of the 2015 repeal bill that President Obama vetoed. This time they’ll incorporate as many replacement components as the rules allow to bring more predictability to insurance markets.
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The conceit that the five major commercial health insurers will consolidate to three seems to be dissolving, as four of those insurers called off a pair of mega-mergers on Tuesday. After 18 months of courtship among the Big Five starting in 2015, the outgoing Obama Justice Department’s antitrust division sued to block the $34 billion Aetna- Humana tie-up as well as Anthem’s $48 billion acquisition of Cigna. Federal judges blocked both transactions earlier this year. Anthem had planned to appeal but on Tuesday Cigna pulled the plug after Aetna and Humana did the same.
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When Dave Hoppe recalls his first big health-care fight, one memory stands out. It was the summer of 1994, and Sen. George Mitchell, the Democratic majority leader, had canceled August recess to force a debate over his party’s health-care monster: HillaryCare.
Senators weren’t happy about losing their break, remembers Mr. Hoppe, who at the time was an aide. “And yet, Republican senators were lining up in the cloakroom; they couldn’t wait to get to the floor,” he says. “They knew this issue. They’d studied it. They were better informed than Democrats about HillaryCare. There was such an esprit de corps. It was energizing.”
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