Policy Analysts Watching Republicans Actions Closely, Staffers Assure Commitment To Repeal Is Ironclad.
BY: Keith Plunkett | UC Staff
Ramesh Ponnoru with AEI summed up in a December 16 article how Republicans would most likely attempt a quick repeal of Obamacare, while being careful to leave certain regulations in place for incoming Health and Human Services Secretary Tom Price to strategically peel away. Ponnoru’s headline summed it up well, ‘Repealing’ Obamacare without repealing it.
However, digging deeper into the logistics of the repeal effort shows just how fragile the crumbling program was and still is. The consensus among conservative policy analysts is that too broad a swing of the axe might reverberate in a way that hastens the departure of health insurance providers who are already itching to jump ship. Lawmakers are also worried that attempts to reduce the regulatory glut built in to the law would entice a filibuster, whereas if they focus only on the law’s tax and spend provisions they can avoid a filibuster through procedural rules.
But, illustrating the fragility of the program, even tinkering with the taxing and spending side is not without risk. Removing just the tax and spend provisions “could cause the insurance exchanges, already in trouble, to collapse entirely. That’s because the Republican bill would scrap the individual mandate while keeping Obamacare’s requirement that insurers treat sick and healthy people alike.”
“The Obamacare law, for the first time, made the federal government the chief regulator of health insurance. And these regulations are responsible for nearly all the uproar about the law. It’s the regulations that caused people to lose their health insurance, contrary to Obama’s if-you-like-it-you-can-keep-it promise. It’s the regulations that have led to high premiums for many plans. It’s the regulations that have undermined the viability of the government’s health exchanges.”
“Yet many Republicans are considering moving quickly on a bill to “repeal” Obamacare without touching its regulations. They hope that the Trump administration uses executive power to loosen those regulations subsequently. But many of the most problematic regulations — like the ones setting a ratio for the premiums that can be charged for the young compared to the old — are in the law itself, and cannot legitimately be modified that way.
“The individual mandate exists because Obamacare’s architects understood that this requirement, on its own, gives healthy people a reason not to buy insurance: They can wait until they get sick and buy it. But the more that healthy people avoid insurance, the higher premiums will have to be — and as they go higher, even more healthy people will stop buying coverage. Insurance markets can’t work that way.”
Philip Klein is managing editor with the Washington Examiner. Klein is one of the leading conservative voices on the subject of health care. He has reported on the ins-and-outs of Obamacare since it’s passage and also wrote the book Overcoming Obamacare: Three Approaches to Reversing the Government Takeover of Health Care released in January 2015.
Klein has been on top of the developing repeal effort as closely or closer than most since Election Day. He has questioned whether Republicans would actually repeal the law, or whether they would just pull spending and celebrate it as a political victory, but attempt to quietly leave in place the mechanisms that allow for the federal government to subsidize the program.
So how can conservatives tell genuine repeal from fake repeal? Klein advises to keep a watchful eye on the spending.
“One of the easiest ways is to look at spending levels. In a Thursday report, the Congressional Budget Office estimated that a straight repeal of the law’s coverage provisions (that is, the Medicaid expansion and exchange subsidies) would reduce spending by $1.75 trillion. In addition, repeal would cut taxes by over $1 trillion, according to an earlier CBO report. When combined, if legislation to repeal and replace Obamacare does not cut spending on Medicaid and insurance subsidies or reduce taxes by an amount at or near those amounts, it can’t be called true repeal.
“The reason why spending levels are so important is that any policy to replace Obamacare has to assume that Democrats will be back in power some day. If Republicans keep the spending levels largely in place, it would be relatively easy for Democrats to restore regulations, reassert federal control, and incrementally increase subsidies. However, if the spending levels are wiped out, a new Democratic administration would be back to square one, forced to come up with trillions of dollars in new spending.”
Klein says conservatives should remain diligent against what he refers to as the temptation for Republicans to “repeal-in-name-only”.
“Instead of falling in line as they often do when a Republican is in the White House, conservatives should be preparing to hold Trump and Congressional Republicans to their word when it comes to repeal. They should beware of RINO-care.
Republicans will need to monitor the market response as they dismantle the monstrous law, avoiding quick moving chain reactions that force a rapid shedding of insured from the rolls or that force providers into more significant losses than was the case in the past year.
A lot is riding on getting it right. And, as Ponnoru writes, calling a bill that doesn’t repeal Obamacare’s central provisions “repeal” provides no escape for Republicans.
Repeal that delays the date of the law’s final expiration for a few years while Republicans try to reach agreement on what to replace it with allows for a small reprieve, but only so far as Republican lawmakers are able to present the public with proposals that will allow for differentiation and competition within regional health care markets. What ails Mississippians health isn’t the same as what ails Americans in other regions of the country.
This is the very definition of subsidiarity, that is, the concept that matters ought to be handled by the smallest, lowest or least centralized competent authority. Healthcare offerings should be based on the decisions by consumers at as local a level as possible, rather than by a central authority. If Republicans keep this one simple conservative principle in mind as they deliberate then the best solution that can be reached won’t be far behind.