Charting A Path To Repeal And Replace
Today's confirmation of Dr. Tom Price as Secretary of the Department of Health and Human Services is an important victory in the fight to repeal and replace Obamacare.
A former orthopedic surgeon from Georgia, Price has been one of Obamacare's most thoughtful and effective critics. And his "Empowering Patients First Act," which he introduced in 2015 while a member of the House of Representatives, remains one of the best GOP replacement plans on offer.
But the real work of repealing and replacing Obamacare has hardly begun. That work starts in Congress. Lawmakers must roll back as much of the health law as possible through "budget reconciliation" -- and then quickly repeal and replace the rest of the law through the conventional legislative process.
Secretary Price can only do so much to undo Obamacare from his position atop the Department of Health and Human Services. He can certainly alter the way the law is implemented and enforced by, say, weakening enforcement of the individual mandate and reevaluating which specific benefits must be part of the "Essential Benefits" package.
But he can't change the fact that Obamacare -- its state and federal exchanges, Medicaid expansion, and regulations -- are the law of the land.
House Speaker Paul Ryan says that Congress could consider a reconciliation measure by the end of March. Reconciliation allows the Senate to vote on legislation affecting the federal budget without the threat of a filibuster. Republicans, of course, have the majority in the House and the required 52 Senate votes -- and so could repeal the components of Obamacare that affect the federal budget.
Those include Obamacare's income-based insurance subsidies, its raft of taxes, and the mandates requiring individuals to secure coverage -- and employers with over 50 employees to offer it. Taxes such as the HIT, Medical Device, Cadillac taxes could also be repealed. Republicans are also exploring how they can include elements of their replacement plan in this reconciliation bill.
But they can't repeal Obamacare entirely via reconciliation. The Senate's rules allow Democrats to filibuster any bill that repeals the law's exchanges or its insurance market regulations -- like the "guaranteed issue" rule forcing insurers to accept all customers regardless of health status and the "Essential Health Benefits" requirements.
Republicans will need to attract eight Senate Democrats' votes to overcome a filibuster and repeal measures like these. And to do that, they'll need to convince them that they have a workable replacement immediately ready.
Fortunately, they do.
Both Price's "Empowering Patients First Act" and Speaker Ryan's "A Better Way" health proposal would replace Obamacare's complicated income-based insurance subsidies with a straightforward age-based refundable tax credit, expand Health Savings Accounts, and convert Medicaid to a block-grant model. They would also permit the sale of insurance across state lines and eliminate Obamacare's onerous insurance market regulations -- including guaranteed issue and the essential health benefits rules.
These policies would inject choice and competition into the health sector -- and expand access to affordable, quality insurance in the process.
Equally important, they should be able to attract support from at least some Democrats.
For starters, Sen. Joe Manchin (D-W.Va.) has already said to Republican leadership that he's "happy to sit down with you to see if we can find a pathway forward."
Manchin is one of five Democratic Senators from solidly "red" states who will be up for re-election in 2018. Another five Democrats are from states that went for Obama in 2012 but flipped to Trump in 2016. And Trump, of course, promised unequivocally on the campaign trail that he'd work to repeal and replace “disastrous” Obamacare.
That's ten Senators who could lose their jobs if Democrats successfully filibuster the GOP's repeal-and-replace effort. Indeed, if they refuse to break with their party, Republicans could easily paint these lawmakers as deliberately obstructing the healthcare reforms that American voters have demanded.
Come 2018, these ten Democrats would have to defend a health law that has saddled Americans with rising premiums, high deductibles, narrow provider networks, and dwindling insurance choice. Worse, they'd be making doing so before an electorate that voted decisively to end Obamacare.
Democrats who side with Republicans will certainly face criticism from their own party. But they'll have to ask themselves if they'd rather bow to the whims of Democratic leaders -- or keep their jobs.
Republicans have a clear path to repealing and replacing Obamacare. Secretary Price can help put their plan into practice. But first, Congress must act -- by passing legislation that simultaneously ends Obamacare and replaces it with reforms that give all Americans access to quality, affordable coverage. Repair or delay tactics will only ensure “Obamacare Forever”.