“It’s time to embrace reality.” That’s what President Obama said about Obamacare on its 5th anniversary in late March.
He meant it as a warning to critics — Obamacare is here to stay, so quit “belly-aching.”
But after five years of false promises, massive disruptions to the healthcare marketplace, enormous costs, repeated delays, and legal challenges, the law has never been more vulnerable than it is today.
Congressional Republicans can use a budgetary procedure called “reconciliation” to repeal Obamacare — and replace it with a market-oriented reform package that gives patients and doctors, not government officials, control over Americans’ healthcare decisions. GOP leaders can’t afford to squander this opportunity.
Republicans in both the House and Senate have already taken the first step toward executing this strategy by approving measures that would balance the budget in a decade and repeal Obamacare in its entirety.
For those unfamiliar with the lawmaking “sausage” factory, the next step in the budget process is for leaders in the House and Senate to form a conference committee to iron out differences between the two budget plans.
Even then, the congressional budget wouldn’t have the force of law. Lawmakers would still need to try to turn these budget promises into legislation through what’s called reconciliation.
This reconciliation bill would go to the president for his possible signature.
Unlike other pieces of legislation, a reconciliation bill cannot be filibustered in the Senate.
In the past, lawmakers have used reconciliation to get tax cuts or entitlement reforms through Congress that a determined minority might otherwise block.
Reconciliation is how Congress passed welfare reform under President Clinton and two tax cuts under President Bush. And it’s how Democrats rammed Obamacare through Congress in 2010 without a single Republican vote, after they lost their filibuster-proof majority in the Senate.
Critics claim that repealing Obamacare via reconciliation is either impossible or foolhardy — especially given that the president has pledged to veto any bill that harms his eponymous law.
Perhaps it would be better, the argument goes, to use reconciliation to enact piecemeal changes to Obamacare that the president might actually sign. Or maybe Republicans should employ reconciliation to push for something else on their agenda, like tax reform.
But voters handed Republicans 13 more House seats and an eight-seat Senate majority last November on the specific promise that they’d do everything they could to repeal and replace Obamacare. To pass up this opportunity would be a slap in their faces.
President Obama might approve piecemeal changes to his healthcare reform law if they accompany other provisions he favors. But there’s no reason to waste a reconciliation bill, which can only be enacted once a year, on such changes.
The president has already repealed major parts of Obamacare on his own. His administration unilaterally discontinued the CLASS Act, an ill-conceived state-funded long-term-care scheme. And he signed legislation that scrapped a requirement that small businesses file reams of new tax forms each year. Bills that would eliminate a tax on medical device companies and the Medicare Independent Payment Advisory Board, which could effectively ration seniors’ care, have enough bipartisan support that they could make it through the Senate on their own.
In addition, the U.S. Supreme Court could very well rule late this June that Obamacare’s text doesn’t allow the federal Healthcare.gov exchange to distribute subsidies for the purchase of health insurance to those enrolled in the 37 states that did not set up their own exchanges.
Should that happen, millions of people in those states could have to pay significantly more for coverage.
The reconciliation process would provide the GOP an opening to push for a complete overhaul of Obamacare as part of any plan to protect those millions who would lose their subsidies from immediate harm.
But even if the high court sides with the administration, and even if an Obama veto is certain, putting a repeal bill on his desk would be an important achievement.
After all, White House propaganda notwithstanding, Obamacare is an ongoing disaster.
Enrollment gains this year were below expectations. Only 11.7 million signed up, of which 8.8 million are on HealthCare.gov. About 20 percent will not end up technically enrolling, as they won’t pay their premiums. Enrollment slowed dramatically in states like California and New York that had done the most to promote the law.
Too few young and healthy are signing up — 28 percent rather than the 40 percent that are needed to prevent premiums from rising. The Congressional Budget Office expects Obamacare premiums to climb an average of almost 9 percent in 2016.
There’s increasing evidence that Obamacare is hurting part-time and lower-income workers and their families. A new survey from the Society of Human Resource Management found that nearly 20 percent of firms either have or plan to cut part-time hours for workers because of Obamacare’s requirement that they provide full-timers health insurance or pay a fine.
Earlier this year, Scott Womack, an Indiana restaurateur, sold his 16 IHOP restaurants because of this employer mandate. “This law will cost my company more money than we make,” he told a congressional committee.
Democrats are now begging Obama to delay a rule that would force companies with between 50 and 100 workers into the small-group insurance market next year. Half a dozen Democratic Senators warned Obama that such a shift would result in “higher premiums, less flexibility, and new barriers to coverage.”
If nothing else, sending a repeal-and-replace bill to President Obama this year would make it crystal clear to the public that there’s only thing stopping Congress from getting rid of this train wreck and replacing it with real health reform.
And that is the current occupant of the White House.