A Second Bite at the Health Care Apple
The GOP's repeal effort isn't dead, and that's a good thing.
Repealing ObamaCare without replacing it is no longer politically or economically tenable, so over the last few days there have been backroom discussions among Republicans about resurrecting a bill believed dead a week ago. (For the record, Mark Alexander bucked the popular narrative in saying the effort wasn’t dead.) A reboot of the American Health Care Act (AHCA) became more likely after Senator Rand Paul, Office of Management and Budget (OMB) head Mick Mulvaney, and President Donald Trump played a round of golf together over the weekend, and it’s likely some concessions were made to help get the House Freedom Caucus on board.
While the language was supposed to be released late Tuesday, as of this writing there’s only speculation as to what the changes may be. The most predicted changes to the original bill would involve eliminating mandates on two of ObamaCare’s most expensive and market-distorting elements: essential health benefits and community rating.
“The real reason why people want ObamaCare repealed,” House Freedom Caucus chairman Rep. Mark Meadows explained, “is because their premiums went up. They could care less about the policy. If the policy had been in and the premiums went down, they’d say, ‘Let’s keep ObamaCare.’”
Eliminating ObamaCare’s essential health benefits requirements — a list of 10 services the know-it-alls in DC decided all health plans must include — would go a long way to reducing premiums. States would be allowed to opt out of mandating that insurers cover certain ailments and services in all policies and could again empower insurers to charge different rates based on the covered person’s gender or overall health.
As for the community rating, critics of its removal claim it would be “bad news for those with pre-existing conditions.” But supporters counter that one reason particular funding mechanisms in the AHCA were being made available to states was to encourage them to set up their own high-risk pools, which were in place in 35 states prior to the adoption of the Affordable Care Act. This would answer the charge of being cruel to people with pre-existing conditions as they could take their complaints up with the several states.
Speaking of the states, Vice President Mike Pence offered a compromise in which states can apply for waivers from ObamaCare’s costly regulations. The conservative Club for Growth, which was instrumental in scuttling the original bill and singled out for blame by Donald Trump, says it’s now ready to get behind Pence’s compromise.
While President Trump was originally inclined to pivot over to tax reform when the AHCA was pulled, over the last few days he’s warmed back up to the idea of redefining federal involvement in health care. “We were very close,” said Trump, but a tight margin and no Democrat support meant he was doing what he thought was politically best all along. “Let ObamaCare explode,” he argued, “and it is exploding right now.”
But is the resurrection of this bill coming at a time that’s politically best?
Because Congress is approaching its Easter break, there are only a handful of legislative days this month. Moreover, the federal budget will take center stage at month’s end as yet another government shutdown looms — the most recent deal to keep Uncle Sam humming along expires on April 28. So while the new compromise measure won’t have to start the process all over — because it was pulled before it got a negative vote on the House floor — there are still a number of hurdles for it to overcome. Getting a vote by week’s end is possible, but may be another case of trying to pass the bill before we know what’s in it.
There are a lot more questions than answers when it comes to intent and adoption. Some may be answered as the text of the amendments leaks out and gets analyzed by all sides of the political spectrum of commentators, but it’s not likely that the new and improved AHCA gets any Democrat votes.
In terms of limiting government, though, the battle for conservatives and federalists may be lost. The Left has succeeded in advancing their ball to where the argument had gone from a straight repeal (bills introduced in this Congress from early on to just last week to do just that have gone nowhere fast) to a situation where only certain portions of ObamaCare will go away. With the AHCA, the most politically popular provisions of the Affordable Care Act will remain and the federal government will give billions to the states to maintain some sort of government health insurance program. And once states grow addicted to this new strain of federal government crack money, it’s unlikely anyone in Congress will make a move to shut off that flow of cash even after it sunsets in a decade’s time.
In a sense, it doesn’t matter what the new AHCA bill actually says. We still can’t find that enumerated power of providing or subsidizing health insurance in our copies of the Constitution. That said, we’re in a distinct minority on that, and Republicans had better work together to keep their promises the best they can.