The orderly transition to a more stable and affordable health-care system is merely beginning. Too much significance is attributed to Republicans adding the word “repair” to their vocabulary, as if this represents a policy change. The insurance markets really do need repair, and doing nothing isn’t realistic amid ObamaCare’s downward spiral. Uncertainty is inevitably priced into premiums, and benefits and rates for 2018 started to be designed and set months ago. They’ll be approved by regulators in the spring, so Mr. Trump’s HHS picks, Tom Price and Seema Verma, need to move fast to bring more predictability to the markets.
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Conservative Republicans, worried about growing voices within the party advising or accepting a slower pace for repealing the Affordable Care Act, are redoubling their push to speed the GOP’s long-desired goal.
President Donald Trump on Sunday became the latest top Republican to sound cautious notes about the party’s ability to rapidly repeal large swaths of the 2010 health law and enact its own vision. He told Fox News’s Bill O’Reilly that “maybe it’ll take until sometime into next year,” saying repeal and replacement was “statutorily” difficult to accomplish quickly.
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As Republicans consider paring back the Affordable Care Act’s federal mandates, they face a difficult question: What does health insurance need to cover?
The 2010 health law created a new set of federal requirements for plans sold to individuals and small businesses, including a list of 10 benefits, among them prescription drugs, mental-health services and laboratory tests. It also mandated that plans cover preventive services such as vaccinations at no cost to enrollees.
The rules, along with other minimum standards set by the law, were meant to ensure that consumers had strong protections and weren’t surprised by unexpected gaps or limits in their coverage. But that also contributed to making individual insurance more expensive in many cases.
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On the question of what should be done about Medicaid expansion under Obamacare, Republicans should combine two ideas popular in their party: block grants and health savings accounts. The former would let states tailor their Medicaid policies to their local communities, while the latter would give enrollees the ability to choose their own insurers and providers. In essence, Washington could give the states Medicaid block grants, allocated per capita, to provide beneficiaries with high-deductible insurance and health savings accounts.
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ObamaCare could never have survived without forcing many more healthy Americans into the system to subsidize those benefiting from the program—exactly what the single-payer program Bernie Sanders and Hillary Clinton endorsed would have done. In scrapping ObamaCare, Republicans should be careful not to shoulder more than the objectives of finding a cost-efficient way to deal with pre-existing health problems, strengthening Americans’ ability to keep their insurance when they get sick or change jobs, and block-granting Medicaid to the states.
If they try to do more, they will be in danger of only changing the name of ObamaCare. They would then own a program that is detrimental to freedom, fiscal responsibility and economic growth.
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Transition relief allowing the creation of ObamaCare-exempt individual markets is only one step toward solving the country’s many health care problems. The broader debate over replacing ObamaCare and reforming the health care system will continue for some time. But these early moves by President Trump’s executive actions are crucial to providing ObamaCare’s hardest hit victims quick relief. States and insurance companies should move with the same urgency that the Trump administration has shown. It’s time to allow the choices that people want also to be the choices they have.
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The provision was buried deep in a 1,000-page bill that Congress passed in December by large bipartisan majorities. Most lawmakers probably didn’t know it was there. Yet it is the start of an answer to the biggest question on Washington’s mind: What to do about ObamaCare?
The 21st Century Cures Act, which President Obama signed Dec. 13, focuses mainly on helping patients obtain breakthrough drugs and medical devices. But it also includes provisions that will give small employers—those with fewer than 50 workers—more flexibility in the insurance marketplace. As Republicans debate how to replace ObamaCare, giving that same flexibility to all employers would be a perfect place to start.
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Lawmakers, insurers and the health-care industry rushed over the weekend to decipher the full meaning and consequences of President Donald Trump’s executive order urging agency heads to do whatever they can to unwind some provisions of the Affordable Care Act.
The order, issued late Friday, encouraged officials to use “all authority and discretion available to them” to waive or delay ACA provisions they deem onerous on individuals, states or insurers. It isn’t yet clear how many provisions officials may choose to apply that to or when, leaving the political and health care worlds in a state of some confusion.
At a minimum, the move signals Mr. Trump’s willingness to take aggressive public aim at the law often dubbed Obamacare, as Republicans in Congress wrestle with their own efforts to dismantle the law and come up with a new health-insurance system in its place.
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President Obama recently warned that if Congress junks the Affordable Care Act, “133 million Americans with pre-existing conditions” will be in jeopardy. That’s a phony figure, for several reasons. The actual number is roughly 500,000.
For starters, half of Americans get their insurance through an employer, according to the Kaiser Family Foundation. Another 34% are on Medicaid or Medicare. For all these people, pre-existing conditions are no barrier to coverage.
Pre-existing conditions mattered before ObamaCare only in the individual market, but even there few were affected. Many of these people with pre-existing conditions managed to get health coverage through the high-risk pools run by 35 states. Those pools covered about 225,000 people in 2011, according to the Kaiser Family Foundation.
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Late last year, House Speaker Paul Ryan (R., Wis.) told a group of senior GOP lawmakers that the person they needed to watch in the Senate in 2017 was Elizabeth.
“Elizabeth Warren?” one lawmaker asked.
“No,” Mr. Ryan replied, according to a lawmaker in the room, “Elizabeth, the Senate parliamentarian.”
Elizabeth MacDonough, the sixth person and first woman to hold the title of chief Senate parliamentarian, will play a crucial role in determining what can be included in legislation enabling the Senate to roll back major parts of the Affordable Care Act with just a simple majority, rather than the 60 votes usually needed.
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