Congress has begun the work of replacing the Affordable Care Act, and that means lawmakers will soon face the thorny dilemma that confronts every effort to overhaul health insurance: Sick people are expensive to cover, and someone has to pay.
The 2010 health law, also known as Obamacare, forced insurers to sell coverage to anyone, at the same price, regardless of their risk of incurring big claims.
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Liberals want to label the Republican repeal and replace effort a failure before the hard work even begins. There is a replace plan, but confusion is raging among the media, perhaps because its details and logic haven’t been explained in public. Congress has a narrow window to use the reconciliation measure early to repeal the law because the procedure is a leftover from the last fiscal year. While the repeal train advances in Congress, the same congressional committees will debate a replacement. This parallel measure will require 60 Senate votes, and the GOP is inviting Democrats to contribute. The replace portion would keep the Obamacare status quo for two or three years to allow a phase-in and orderly transition, but the GOP won’t wait two or three years to design the new system.
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President Obama and Vice President-elect Mike Pence both paid a visit to Capitol Hill Wednesday, in the first formal engagement over the future of the Affordable Care Act. Republicans finally have the power to repeal, but the question is whether they have the grit to replace ObamaCare.
Mr. Pence told Republicans that repeal and replace is the Trump Administration’s “first order of business,” while Mr. Obama ordered Democrats not to “rescue” the GOP by helping to pass a “TrumpCare replacement.” Going by his business background Donald Trump won’t mind putting his name on a health-care plan, or anything else, but Republicans need to appreciate the reality that they will soon own ObamaCare. Until they pass a coherent and market-oriented substitute, as a political matter ObamaCare is TrumpCare, like it or not.
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With Republicans controlling both ends of Pennsylvania Avenue next year, they have a great, and rare, opportunity for reform. The question now is whether Donald Trump and a new congressional generation can enact center-right reform solutions, and the first proving ground will be ObamaCare. If Republicans don’t repeal the law immediately, the danger is that the natural inertia of Congress takes over and nothing changes. But the more time they put between repeal and replace, the more the danger will grow. Now’s the chance to show they can reform the entitlement state with solutions that improve the daily lives of Americans.
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The worm is about to turn in health policy and politics when Republicans shift from throwing stones to owning the problems of the health system and the Affordable Care Act or its replacement, as President Barack Obama and Democrats have for the past eight years. It’s hard to predict how events will play out, but it’s likely that grand plans to repeal and replace Obamacare, convert Medicaid to a “block grant” program, and transform Medicare into a premium support program could be whittled down or delayed as details of such sweeping changes, and their consequences, become part of the debate.
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Republicans on Capitol Hill are grappling with the likelihood that they will need Democratic support to pass parts of any plan replacing the Affordable Care Act, setting up a complex legislative battle over the law’s future.
President-elect Donald Trump is expected in his first days in office to take executive action voiding parts of the health law that the administration has discretion to change. Soon after that, lawmakers likely would start on their efforts to repeal and replace the law.
With full control of Congress and the White House, Republicans have anticipated being able to repeal the law using a special budget maneuver that would allow them to get around a filibuster by Democrats in the Senate.
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The new direction of American health care should be fully consumer driven, empowering individuals to be the surveyors and purchasers of their care. If President-elect Trump and Rep. Tom Price, Trump’s HHS pick, want to make the most of this short window, they should keep four central reforms in mind: 1) Provide a path to catastrophic health insurance for all Americans. 2) Accommodate people with pre-existing health conditions. 3) Allow broad access to health-savings accounts. 4) Deregulate the market for medical services.
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On Donald Trump’s victory Republicans in Congress are primed for an ambitious agenda, and not a moment too soon. One immediate problem is ObamaCare’s expansion of Medicaid, which has seen enrollment at least twice as high as advertised.
Most of the insurance coverage gains from the law come from opening Medicaid eligibility beyond its original goal of helping the poor and disabled to include prime-age, able-bodied, childless adults. The Supreme Court made this expansion optional in 2012, and Governors claimed not joining would leave “free money” on the table because the feds would pick up 100% of the costs of new beneficiaries.
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When the new Congress and President-elect Trump take office in January, Republicans will have a real chance to repeal President Obama’s Affordable Care Act. If they succeed, it will be the result of their carefully executed strategy to repeal the law and repeated congressional votes to do so. This approach was the subject of much derision from Democrats, but sticking to it has now put the Republicans in a position where they can reach their goal.
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Democrats are already panicked that Donald Trump will repeal ObamaCare and throw millions of people off the subsidy rolls, while some conservatives seem panicked that the President-elect will renege on his campaign promises and millions of people won’t be thrown off the entitlement. Like most inflamed political questions after Mr. Trump’s victory, the health-care debate would benefit from some perspective.
“Either ObamaCare will be amended, or repealed and replaced,” Mr. Trump told the Journal last week, and on “60 Minutes” on Sunday he added that “we’re not going to have a two-year period where there’s nothing. It will be repealed and replaced.” Mr. Trump is being more subtle than his critics.
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