Robin Smith / Dec. 3, 2018

ObamaCare Repeal Didn’t Happen But…

The Trump administration is doing a number of things to weaken the law and strengthen the market.

One of the top issues of the 2018 midterm elections was health care. In the coming years, expect the divide over the issue to expand, not contract, due to activity by the courts and the Trump administration. ObamaCare wasn’t repealed as promised by Republicans, but the law is in intensive care with a prognosis that, to the government-control crowd, is grim.

It’s important to note an important distinction in the discussion about health care: Health insurance doesn’t necessarily translate into low-cost health care.

Democrats now demand single-payer health insurance that puts the government in charge of all care, all costs, all decision-making and, simply, placing every American on Medicare as their insurance. Republicans claim they want to reduce health care costs to increase access by driving down expenses through price transparency, market competition, and consumer control. Yet while having the White House and both chambers of Congress, all Republicans have managed is some deregulation from the Trump administration and effectively repealing the tax penalty for the individual mandate.

Expected in the next few weeks is a decision in Texas v. Azar that will rule on the constitutionality of the individual mandate. Remember that Chief Justice John Roberts was the swing vote that determined the individual mandate could be enforced as a tax but could not be enforced as a mandate to purchase a product. In the convoluted thinking that Congress was prohibited from forcing Americans to purchase a service or good, Roberts, instead, decided Congress could constitutionally assign a tax for not purchasing said service or good.

Republicans, as part of the tax reforms of 2017, left the tax mandate in the law but cut the penalty to zero. The argument in Texas v. Azar is that a tax of $0 is no tax at all, which undermines the constitutionality.

Should the federal judge rule that the individual mandate is now unconstitutional, Democrats will launch into hysterics and Republicans are just as likely to join them in legislating a “fix” for the failed policy Dems created in 2010 without a single GOP vote.

There’s a second factor that caused a Democrat head-explosion last week, and it will keep health care in the headlines. The Centers for Medicare and Medicaid Services (CMS) issued guidance to states to seek waivers to redefine how subsidies may be used for individuals qualifying for financial support to purchase insurance coverage that include the plans that don’t meet the minimum benefit standard for the bronze, silver, and gold plans of the “Affordable” Care Act exchanges. These exchange plans have been characteristic of extremely high premiums and deductibles with extensive coverage of care — some needed, some unneeded. For instance, a 45-year-old single male does not need to purchase a plan that features gynecological visits. Yet the ACA has a blanket policy for minimum benefits. Simpler, younger, healthier individuals are paying to subsidize the sick by purchasing too much care that they either don’t use or never benefit from a covered service because they fail to meet their deductible.

These two current developments, in addition to the Trump administration’s efforts over the last two years to redirect some of the spending of ObamaCare to the control of the individual or the states, are guaranteed irritants of the socialized medicine crowd. Trump has worked to loosen the government control over health insurance by eliminating the employer mandate, rejecting cost-sharing subsidies (meant as a bailout of insurance companies that were sure to face unsustainable costs), and signing the executive order permitting insurers to sell cheaper catastrophic plans as well as plans to associations outside the federally regulated marketplace.

Since ObamaCare repeal didn’t and won’t happen, the only hope to see the costs of health care reduced will be if the states act swiftly to seek these waivers issued through CMS to essentially block-grant monies that would’ve otherwise been controlled by federal mandates. States can, and should, in turn, find creative ways to establish their own health care markets that feature price transparency to engage patients in seeking the most cost-effective health services. States can also engage in using things like tiered copays to incentivize healthier behavior and choices.

The American public consistently reports through polls and surveys that they want to see health care costs reduced. Don’t mistake that for health insurance coverage. The proof is in the Kaiser Family Foundation tracking poll released last week that showed of the 18-64-year-olds who qualify for ObamaCare subsidies and, under the current law, should purchase plans, four in 10 reported they were planning to forego coverage in 2019. Of the same population, only 24% were aware that the enrollment deadline for coverage is Dec. 15.

Americans want access to reasonably priced health care services and medicine. Just as Americans who purchase a plan for their smartphone do so based on their personal needs, consumers would prefer to have insurance, in its most authentic sense, to cover catastrophic needs like trauma, surgery, and long-term care to avoid financial ruin, while paying a reasonable amount for regular check-ups, medicines, and procedures.

Will solutions come about the cost of health care? Yes, if states step up and operate as the laboratories our Founders intended by putting patients in charge of making decisions on their health care, seeing the prices, and paying the bills. Otherwise, be ready for $32 trillion for Medicare for all.

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