What’s Next For Repeal And Replace — 100 Days Into Trump’s Presidency

We’re more than 100 days into Donald Trump’s presidency, and Obamacare is still the law of the land. That’s disappointing — but not catastrophic.

Indeed, President Trump himself said last week that he was “disappointed” in House Republicans for failing to pass a bill to repeal and replace Obamacare thus far.

Moreover, the latest incarnation of the American Health Care Act — which would allow states to opt out of certain of Obamacare’s provisions — is a far cry from the full-scale repeal and replacement that the president promised voters on the campaign trail.

But in his first hundred days, the president has made progress in his drive to “repeal and replace disastrous Obamacare.” It’s now up to Congress to present Trump with a bill that would allow him to make good on that promise.

President Trump started his assault on Obamacare with a bang. On his first day in office, he signed an executive order instructing the Department of Health and Human Services to waive, defer, or delay the implementation of any provision within Obamacare if doing so would ease financial burdens on businesses and consumers.

This order set the stage for a host of constructive insurance-market reforms announced in early April by HHS Secretary Dr. Tom Price. To discourage people from waiting until they get sick before buying coverage — so-called “adverse selection” — Price cut the open enrollment period on the exchanges roughly in half, to six weeks.

His reforms also let insurers collect unpaid premiums before allowing a patient to sign up for an exchange plan the following year.

This is a simple matter of common sense. The Obama administration was obsessed with boosting coverage numbers, so it had little incentive to prevent individuals who hadn’t paid premiums from renewing their coverage. But forgiving those debts is a little like giving people permission to walk out of a restaurant without paying for their meal.

People seeking to purchase coverage outside the open-enrollment period, meanwhile, must provide additional identification under the new rules.

This much-needed reform is intended to crack down on fraud. In an undercover operation conducted last year, the Government Accountability Office sent 12 applications for fictitious patients — six to the federal exchange and another six to marketplaces in the District of Columbia and California. Nine of those 12 fake individuals secured subsidized coverage outside the open enrollment period.

Price’s rules also provide greater flexibility to insurers in determining a plan’s actuarial value — the percentage of medical costs covered by a given policy. By permitting insurers to offer plans with lower actuarial values, the Trump administration will expand the number of low-premium options available to consumers.

Trump has also taken steps to fix the scandal-plagued Veterans Health Administration. Last Thursday, he signed an executive order creating the Office of Accountability and Whistleblower Protection — a reform that should make it easier for Veterans Affairs Secretary David Shulkin to fire incompetent agency bureaucrats.

These are small improvements, to be sure. But they’re better than nothing.

Congress now needs to give the Trump administration an assist. It missed Trump’s first deadline — Day One of his administration. And it’s missed the 100-Day mark. But the legislative branch is moving — albeit slowly.

House Freedom Caucus chairman Mark Meadows, R-N.C., and the co-chair of the moderate Tuesday Group, Tom MacArthur, R-N.J., have brokered a deal as part of the latest version of the American Health Care Act that would give states the ability to opt out of some of Obamacare’s most destructive rules and regulations.

States could apply for a “Limited Waiver” that would allow them to drop Obamacare’s community rating rule beginning next year. This rule prohibits insurers from charging different prices to patients of the same age or gender according to their health status. In order to obtain such a waiver, states must establish a high-risk pool that offers affordable coverage to sick patients with unusually high medical expenses.

The compromise also lets states alter Obamacare’s age-rating rules, which currently ban insurers from charging older patients any more than three times what they charge younger patients. The new ratio would be 5:1, which more closely parallels the actual ratio of older people’s health costs relative to those posed by younger ones. Waiver states would have the option to expand that ratio even further.

Finally, the compromise would allow states to waive Obamacare’s essential health benefits mandates — and set up their own alternative benefit requirements starting in 2020.

Make no mistake — this is not the “repeal and replace” effort Republicans promised. Under the emerging House Republican proposal, many states may decide to keep Obamacare indefinitely. And since these waivers would only be valid for 10 years, a future Democratic presidential administration could potentially restore Obamacare in waiver states.

Nevertheless, this is likely the last chance House Republicans will get to deliver even partial repeal of Obamacare to the Senate. So it’s critical that this latest run at reform not fall apart.

The House Freedom Caucus appears to have gotten behind the Meadows-MacArthur amendment. But several of MacArthur’s moderate colleagues are not on board.

Consequently, House Speaker Paul Ryan has held off on bringing the revised American Health Care Act to the floor for a vote. The GOP doesn’t yet have the 216 tallies it needs to pass the bill.

The party has no choice to but to find them. Once the House passes a bill, potentially in May, the Senate can work to strengthen the legislation as much as is possible under the budget reconciliation process.

The voters who swept Donald Trump into the White House — and gave Republicans control of both chambers of Congress — likely expected that Obamacare would be history by now. Congress and the president must give the people the repeal-and-replace plan they voted for — even if it takes another 100 days.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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