Republican Senators Try a ‘Hail Mary’ On Obamacare

After their embarrassing failure to repeal and replace Obamacare over the summer, Republicans in the Senate are gearing up for a “Hail Mary” attempt to at least make a modicum of reforms to the health care law. The Senate, where the previous attempt to rein in Obamacare died, may vote on the last-gasp effort by the end of September.

As explained previously in The Resurgent, Republicans cannot fully repeal Obamacare without 60 votes. The previous attempt at reforming Obamacare fell apart over details of how the law’s subsidies should be treated and how to handle medical care for the uninsured. Moderate Republican support for the ACA’s expansion of Medicaid also caused serious problems in crafting a replacement bill.

The new bill, written by Senators Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), is much more modest than the failed American Healthcare Act. The proposal doesn’t completely repeal Obamacare, but does replace Obamacare’s tax subsidies with state block grants, repeals the individual mandate and scales back the Medicaid expansion.

“It’s basically federalism where you just block grant the whole thing,” Speaker Paul Ryan (R-Wisc.) told the Washington Examiner. “You block grant Obamacare back to the states. Just the whole thing.”

Majority Leader Mitch McConnell (R-Ky.) has indicated that he will bring the bill to the floor for a vote if at least 50 of the 52 Republican senators support it. At the moment, the bill is short of that mark, but Politico reports that it is gaining steam after Graham publicly lobbied President Trump and others. Estimates put Republican support for the bill at 48 or 49 senators.

The bill appears to be on a fast-track. The Washington Post reports that Republicans have already submitted it to the Congressional Budget Office for analysis. If the bill is not passed before the end of September, the Post notes that the authority to pass the legislation with a simple majority under budget reconciliation rules would expire. This would effectively kill any attempts to reform Obamacare until next year.

If the bill does pass the Senate, it faces an uncertain future in the House of Representatives. The previous bill, which originated in the House, had to be finely tuned to pass by a slim majority. Under budget reconciliation rules, the House would have to pass the Graham-Cassidy bill with no changes.

No Democrats are expected to support the bill. Sen. Elizabeth Warren (D-Mass.) tweeted, “The Graham-Cassidy @SenateGOP ‘health care’ bill IS Trumpcare, & it will rip health care away from millions of Americans.”

As with the previous Obamacare reform bill, opposition to the bill is expected to come from the right as well as the left. Senator Rand Paul (R-Ky.) has announced that he will oppose the bill, calling it “Obamacare lite.” If Paul stands firm, the defection of any other Republican will doom the bill.

Paul’s stance against “Obamacare lite” begs the question of whether he and the Freedom Caucus would prefer the full version of Obamacare to an imperfect Republican reform bill. For the foreseeable future, those are the only two options.

Bernie Sanders to Introduce Medicare-For-All Bill

In an op-ed for the New York Times, Senator Bernie Sanders (I-Vt.) says that he plans to introduce a bill that would replace private health insurance with Medicare for “every family in America.” Sanders, who bills himself as a democratic socialist, believes that the answer to the Obamacare crisis is more government control of the nation’s healthcare.

Under the Sanders plan, a four-year transition period would move the country from private health insurance to a national single-payer plan. Sanders describes the details of the transition:

“In the first year, benefits to older people would be expanded to include dental care, vision coverage and hearing aids, and the eligibility age for Medicare would be lowered to 55. All children under the age of 18 would also be covered. In the second year, the eligibility age would be lowered to 45 and in the third year to 35. By the fourth year, every man, woman and child in the country would be covered by Medicare for All.”

Sen. John Barasso (R-Wy.) pre-empted many of Sanders’ arguments in a Tuesday op-ed on Fox News. Barasso, a medical doctor, pointed out that single-payer plans in other countries have not worked out well. “The British have found rationing necessary partly because of the exorbitant cost of ‘free’ medical care,” he wrote. Barasso also cited “the shortage of professionals to provide this care” as the number of British doctors, nurses and midwives has dropped in recent years.

While Sanders and others cite poor outcomes of American healthcare, Barasso points out, “The U.K. ranks 20th out of 24 western countries for breast cancer survival. The U.S. is first. For ischemic stroke the U.K. is 25th out of 30 countries. The U.S. is fourth.”

While Sanders’ proposal will be a nonstarter in the Republican-controlled Congress, it could portend things to come if Democrats return to the majority. Opinion polls in recent months have indicated a growing support for a federal role in healthcare. Pew Research found that 60 percent of Americans say that it is the federal government’s responsibility to ensure healthcare coverage for all Americans. Last spring, an Economist/You Gov poll found that that 60 percent favored a Medicare-for-all approach. That number includes 40 percent of Trump voters.

While most conservatives and Republicans will ridicule Sanders’ proposal as radical and dead-on-arrival, the idea of Medicare-for-all might have broader appeal than they suspect. If conservatives do not confront the idea head-on by enacting a better proposal, it is very possible that Republicans could face an invigorated Democratic Party in 2018 and 2020.

It is a cautionary tale to recall that Republicans defeated Hillarycare in the 1990s, but then failed to enact healthcare reforms of their own during the Bush Administration. That failure led directly to the election of Barack Obama and the Affordable Care Act.

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BREAKING: Governors Considering 2020 Unity Ticket




Casual discussions are underway between the camps of governors John Kasich (R-OH) and Hickenlooper (D-CO) to form a unity ticket in 2020, presenting an alternative to the Democrat and Republican nominees for president, according to sources familiar with the conversations.

Recently, the two governors have been working on an alternative healthcare reform plan to present to others, particlarly congress. Both governors were elected around the same time (Kasich in 2010, Hickenlooper in 2011) in mixed-party states, and immediately accepted Medicaid expansion under the Affordable Care Act. Both oppose the repeal of the the Act.

Barring a surprise star in the ranks, Democrats are not expected to field especially strong candidates in the next two years in preparation for 2020, and presumably, Donald Trump will be the GOP nominee for a second time, unless directly challenged by members of his own party. If they choose to join forces, their likely target would be the majority in each party that polls indicated dissatisfaction with their respective candidates.



While third-party candidates struggle for both funding and name recognition, these men have advantages most third-party candidates don’t. National profiles in each party, independent streaks, and media-friendly relationships and donor networks. And presumably, they carry less baggage or idiosyncrasies that the other “Governors squared” campaign with Johnson/Weld in 2016.

Governors tend to work well together, and share camraderie more than most partisan leaders, and these two governors are no exception.

Gov. Hickenlooper, a Democrat, has tended toward the centerline and his party, trying to carve out a reputation for working across the aisle. Gov. Kasich of course has been riding the middle line since his first days in the 2016 campaign, and stayed in until the last stretch of the Republican primary. He earned his stripes first years ago, however, not only accepting Obamacare expansion in his state, but traveling to other state capitals to lobby fellow Republicans to do the same.

Some believed that his continued presence helped to split the non-trump crowd in the primaries – roughly 60% until the end – especially toward the end, when it was mathematically impossible for him to win, and Senator Cruz still had a chance to capture remaining delegates.

National Review’s Matthew Continetti observed at the time, “The Ohio governor has won a single state: his own. He has 143 delegates. That puts him fourth in the count behind Donald Trump, Ted Cruz, and Marco Rubio — who is no longer a candidate. To win the nomination on the first ballot of the Republican convention, Kasich would have to win 138 percent of the remaining delegates. This is impossible. Even a politician should be able to do that math.”

Now, it appears that winning the nomination may not have been his end game.

 

Why Does Senator Sasse Wants to Keep the Filibuster?




How many of you have seen “Mr. Smith Goes to Washington?”

If you haven’t, you are without.

This Jimmy Stewart gem is a must-see for any political junkie like myself, and tells the story of a regular guy roped into running for office by a slick politician, then standing up against corruption once he got there. Because of Senate rules, he was able to hold up the government taking action on something that the corrupt politician’s party supported. The rule was the filibuster.

The filibuster rule is one that says you need 60 votes to accomplish anything in the 100 member Senate, or to at least debate it on the floor. With roots in the ancient Roman Senate, parliamentary rules were used by Cato the Younger to resist Julius Caesar’s autocratic methods by simply talking non-stop until it was dark and Senate business had to cease. It took hold in the United States in the early 1800’s and naturally evolved from the Founder’s intent to make the Senate move slowly.



Votes can pass by a simple majority, but one member – according to the rule – can hold up action on legislation if they feel it is harmful. Traditionally, Senators would have to stand to object, and stay standing, as they debated. Occasionally, a Senator could pass the baton to another colleague in their cause by “taking a question.”

Unfortunately, the filibuster has devolved over the years to be a political tool of opposition, where even the threat of one is enough to freeze business on a subject. Representatives in the House chide their colleagues, saying often, “the other party is the opposition; the Senate is the enemy.”

Over a year and a half ago, Senator Ben Sasse (R-NE) wrote an almost prophetic op-ed on the virtues of the Senate filibuster. While acknowledging the “frustrating” aspects of slow-moving government, and it’s abuse by minority parties, he gave readers a primer in why this is a good thing. Especially as conservatives.

After all, we were the minority party just two years ago, remember?

While the House of Representatives was designed by the Founders to reflect the democratic will of the people, representing smaller, disparate populations, and elected every two years, the Senate was intended to be the opposite.

James Madison recognized the historical nature of a pure democratic body, and wrote:

“The necessity of a senate is not less indicated by the propensity of all single and numerous assemblies, to yield to the impulse of sudden and violent passions, and to be seduced by factious leaders, into intemperate and pernicious resolutions.”

So, does removing the filibuster help in pursuing that goal?

Senator Sasse made the point that while progressives believe the government is the ultimate source of human wellness and societal improvement, conservatives are far more skeptical. We believe that government cannot accomplish either of those things as well as private individuals and organizations, and will always fail. It often creates new problems in addition to failing to solve the previous ones.

Therefore, we want government to struggle to act. And where it does, it should be as local as possible, right? This is the greatest value of a filibuster.

Right now, we stand in an awkward and maddening place between progressives briefly having a filibuster-proof Senate in 2009-’10 (seven months) and our current 53 vote majority. While most legislation can pass by a simple vote, the political mess and party division has created a dynamic that makes even that difficult to achieve, let alone the passive acceptance of a vote by seven Senators from the opposition party. The only answer on the most controversial topics would be to have a 60 vote majority.

Weren’t we grateful for this stopping most of President Obama’s and Senator Reid’s radical agenda after 2010?

In fact, it was this rule that held off for years the passage of things like the Federal Reserve Act in 1913 and the liberal court-packing attempted by Franklin D Roosevelt in the 30’s. The only reason Obamacare was passed in 2010 was because of a slim window where the Democrats had 60 votes to “reconcile” the House bill. So, it stands to reason we need the same threshold now to reverse it.

And yet, its the failure of the Obamacare repeal effort in the Senate that has some Republicans calling for the removal of the filibuster (a rule that itself only needs a majority to exist).

Senator Sasse makes a strong point for why this is more dangerous than letting Democrats have this power now.

“Progressives believe power—that is the government—is the center of life. We don’t. They place more faith in government than we do. They want to make it easier, more “efficient,” to grow the government. So making it easier for government to act when Republicans are in the majority might have consequences we will regret when we are next in the minority.

“Consider the three most consequential moments in the growth of federal power in the past century—the 1930s New Deal, the mid-1960s Great Society programs, and the first two years of this administration that brought us, among other things, ObamaCare. All occurred when Democrats had the White House, a majority in Congress and, crucially, supermajorities in the Senate. They could act unimpeded by a Republican minority.

“If Republicans eliminate the Senate’s supermajority requirements to pass bills in the name of efficiency, it will guarantee that every time Democrats have the presidency and even a bare majority in both houses of Congress, they will party like it’s 1936, 1965 and 2009. They will grow government, and there will be nothing conservatives can do about it.

“Imagine what Democratic majorities could do with no Senate filibuster: cap and trade, a national gun registry, federal abolition of state right-to-work laws, the abolition of secret-ballot union representation elections in favor of card checks, record tax increases. Everything would be in play. Such a Congress could tick off every box on Bernie Sanders’s wish list, and conservatives would have handed them the cudgel to do so.”

Now, do you still think we should get rid of it?

If you do, you’re not a thinking person.

That being said, Rep. Tom McClintock (R-CA) sees a better solution for reforming the modern filibuster rule without discarding it. He gave a speech earlier this year at Hillsdale College on the subject of reforming the rule, and I thought it was worth sharing some of it here.

Rep. McClintock says of the filibuster:

“This parliamentary principle assumes that there is an actual debate, that it is germane to the subject at hand, and that it is not conducted in a manifestly dilatory manner.

“Within a few decades of the American Founding, senators rediscovered Cato’s practice of killing a bill by killing time, and the Senate filibuster was born. Yet it was rarely used because of its natural limitations. A filibustering senator had to remain for the most part at his desk and on his feet.

“In 1908, for example, Sen Robert La Follette of Wisconsin held the floor for 18 hours—speaking for long periods of time, and demanding dozens of quorum calls and rollcall votes—to stall a banking reform bill. The bill eventually passed, but not without significant consternation on both sides, due to the fact that until the filibustered matter was disposed of, the Senate could not move on to other business.”

The intended use of the filibuster was watered down however, starting in 1917, when the Senate imposed a super-majority threshold called “cloture,” first set at two thirds (66 today), then three fifths as it is today. Debate could be ended if the supermajority wished to move on. This still seemed a reasonable, but needed reform in changing times. It still required the physical act of standing at your desk and speaking. The rule was only invoked 58 times between 1917 and 1970.

However, this is when the filibuster met it’s match: if you can’t beat it, beat it to death.

In 1970, Senate Majority Leader Senator Mike Mansfield (D-MT) changed the rules to allow a “two-track” system where filibustering is now a virtual act, able to be passed over so the Senate can move onto other business. As a result, filibusters increased from roughly one a year to 37 a year, with few resolutions. Over five years, the Senate gutted the rule to get more legislation passed. This means a bill can essentially be filibustered by the simple threat of one, rather than by the intended physical opposition of something. Whereas the purpose of the filibuster was to force a delay to debate something, the “two-track” rule eliminated debate, and codified partisan division.

A wise man once told me, “don’t air your grievances yet, unless you have a solution first.” So, here it is, as delivered again by Rep. McClintock.

First, the Senate should get rid of the two-track system that allows it to bypass a filibustered bill and reinstitute the pre-1970 requirement that filibusterers hold the floor.

Second, the Senate should restore the parliamentary principle that debate must be germane to the pending piece of legislation. (Sorry Ted, no more Green Eggs & Ham. But I’m sure you’d find a way.)

Rep. McClintock provided three additional suggestions (which can be read in full here), but I believe these two would restore the dignity of the filibuster while resolving some of the legitimate concerns of do-nothing politics. The only reform I would add is unlikely, but equally important, in my view: repealing the 17th amendment. I discuss that in more detail HERE.

So in closing, yes, the level of resistance by the Democrat Party is incredibly stupid right now, but they viewed ours the same way just a few years ago. This is the way government works, and as Sen Sasse pointed out, that’s the way we should WANT it to work. To fix it, we should follow the advice of Rep. McClintock and get rid of the “two-track” filibuster process and send Mr. Smith back to Washington the way he should be.

Meanwhile, we should keep making America great on the local level while the feds play with political fidget spinners. That’s how it was supposed to be anyway.

 

‘Outsiders on the Inside’ | Congressman Tom Garrett of Virginia’s 5th District




Our fourth guest for “Outsiders on the Inside” is Rep. Tom Garrett of Virginia’s 5th District. Newly elected to the House of Representatives, Rep. Garrett is setting out a bold conservatarian agenda and pulls no punches. We discussed Obamacare repeal, gun rights, his district, and what’s challenging about being an outsider here in the nation’s capital.

Below is a teaser:

 

Watch our full exclusive interview with him below:

Connect with Rep. Garrett on Twitter and Facebook.



McConnell Criticized For Pelosi-Like Tactics On Health Bill




Majority Leader Mitch McConnell (R-Ky.) is facing questions about his leadership after the Obamacare repeal debacle. Many Republican senators are criticizing McConnell’s strategy of crafting the bill in secret without input from members of the GOP caucus.

Lisa Murkowski (R-Alaska), a consistent no vote on health care reform, said that she was often in the dark about what the most current version of the bill contained and lamented that she didn’t have time to study the draft legislation before voting.

In a situation reminiscent of Nancy Pelosi’s statement that Congress needed to vote on Obamacare to see what was in it, Murkowski told The Hill that, under McConnell, it was like “It’s 10 o’clock and we’re going to vote on it in two hours, what do you think, gang?”



John McCain (R-Ariz.), who cast the deciding vote to kill the healthcare bill, cited the secrecy surrounding the drafting of the bill as a reason to vote against it. McCain said in a statement, “We’ve tried to do this by coming up with a proposal behind closed doors in consultation with the administration, then springing it on skeptical members, trying to convince them it’s better than nothing, asking us to swallow our doubts and force it past a unified opposition. I don’t think that is going to work in the end. And it probably shouldn’t.”

Other senators agreed with Murkowski’s criticism of the closed-door drafting of the legislation. In June, Sen. Mike Lee (R-Utah) said in a Facebook video, “Even though I’ve been a member of this working group among Senate Republicans assigned to help narrow some of the focus of this, I haven’t seen the bill.”

“And it has become increasingly apparent in the last few days that even though we thought we were going to be in charge of writing a bill within this working group, it’s not being written by us,” Lee continued. “It’s apparently being written by a small handful of staffers for members of the Republican leadership in the Senate.”

Ron Johnson (R-Wis.) went further a few weeks later. After a report by the Washington Post that McConnell told moderate Republicans that Medicaid cuts in the bill would not happen because they are so far into the future, Johnson told the Green Bay Press-Gazette that McConnell’s comments were a “breach of trust.”

Even without arousing the anger and suspicion of Republican senators, there was always a narrow window to pass an Obamacare reform bill. The Republican majority of only two votes meant that McConnell “needed to pitch a perfect game,” one senator told The Hill. “Unfortunately, he pitched a two-hitter,” the senator continued.

The criticism doesn’t mean that McConnell’s leadership will be challenged anytime soon. No Republicans are stepping up to contest the Kentucky Republican’s position at the helm of the Senate. As Republican failures mount, that could change.

It is widely expected that the next step for the GOP is to tackle tax reform, an issue that faces many of the same challenges as healthcare reform. If Republicans use the budget reconciliation to avoid a Democrat filibuster, permanent changes would have to be scored as not adding to the deficit by the Congressional Budget Office. As with the healthcare bill, Republican moderates will be under intense pressure from the media and Democrats and it will only take three Republican defections to kill the bill since no Democrats are expected to vote yes.

After six months of stinging defeats in Congress, Republicans badly need a legislative victory to shore up the conservative base. Republican voters are angry at what they see as a betrayal of one of the party’s core promises. If Republicans can show no results from their majorities in both houses of Congress, Republican voters may stay home in November 2018. That could imperil McConnell’s position as majority leader even more surely than a revolt among Republican senators.

Trump to Decide Whether to Continue Obama’s Unconstitutional ObamaCare Subsidies




During an appearance on this week’s edition of “Fox News Sunday,” White House counselor Kellyanne Conway said that President Donald J. Trump would decide this week if his administration will continue to make cost-sharing reduction payments to insurance companies.

The payments, called CSRs, subsidize insurers for reducing co-pays and deductibles for low-income Obamacare customers.

When asked by moderator Chris Wallace if Trump was going to cut off those payments, Conway said, “He’s going to make that decision this week and that’s a decision that only he can make.” Here’s the exchange from the Fox News transcript:

WALLACE: Is the present going to cut off the CSR payments, the out-of-pocket payments? He can do it starting next month, this week.

CONWAY: Yes, he can. He can — he’s going to make that decision this week, and that’s the decision that only he can make.



But let’s go back to what we are really talking about here. When he said yesterday in the same tweet, I believe, about the bailout — the insurance companies’ bailout from members of Congress, he’s talked about the CSR payments. He’s also talking about this really sweet deal that members of Congress and their staffers have where they are not beholden to the same health healthcare that so many Americans say is unaffordable and unsustainable and untenable.

And this is exactly what so many Americans hate about Washington, D.C. They feel like they have their nose pressed up against the glass, peering into the special interests, the swamp, these lobbyists, the folks on Capitol Hill. They want people to live under the same rules they do. And, frankly, if people had the same rules on Capitol Hill, maybe they would have a stronger taste of what it feels like to be in a short — what it feels like —

WALLACE: Kellyanne —

CONWAY: — to have to choose between paying your premiums and paying your grocery bill.

President Obama’s CSR payments have been found unconstitutional. On May 12, 2016, United States District Judge Rosemary Collyer of the federal district court for the District of Columbia decided that the Obama administration could not constitutionally reimburse insurers for the costs they incur in fulfilling their ObamaCare obligation to reduce cost sharing because Congress had not appropriated money to cover the CSR payments.

As Timothy Jost explains, the lawsuit was an attempt by the Republican-controlled House of Representatives to hold President Obama responsible for his abuses of presidential power. On July 30, 2014, the House voted to file a lawsuit challenging the President’s implementation of the law. The complaint, filed on November 21, 2014, focused on two issues: the decision by the Obama administration in 2013 to delay the implementation of the employer mandate for a year, and the funding by the administration of the Affordable Care Act’s CSR payments, without an explicit appropriation.

Judge Collyer’s decision was a clear victory for the House of Representatives.

The Washington Examiner reports that President Trump has threatened to allow Obamacare to collapse and implode after Congress failed to pass legislation to repeal and replace the Affordable Care Act. President Trump also said on Twitter that he wants the Senate to keep working on healthcare after Republicans were unable to get the votes for a “skinny repeal” bill last week.

As Conway told Wallace, President Trump isn’t willing to move on to other legislative priorities just yet:

CONWAY: The president will not accept those who said it’s, quote, time to move on. He wants to help the millions of Americans who have suffered with no coverage. They were lied to by the last president. They couldn’t keep the doctor. They couldn’t keep their plan.

We’ve met with the ObamaCare victims at the White House several times now. They’re real people, they’re suffering.

And when he talks about the 51 votes, the president is basically making the case that so many of the components of real healthcare reform, Chris, requires 60 votes — the drug pricing, the selling of insurance across state lines, the associated health plans that allow those who don’t get their health insurance to the employers like you and I do, or to government benefits, who have been left out because the premiums are too high.

Premiums have doubled. We see in some states that there are no insurers —

(CROSSTALK)

WALLACE: Let’s talk about that. Kellyanne —

CONWAY: So, he will. He will stick with it.

If President Trump refuses to continue Obama’s unconstitutional CSR payments, Obamacare will have even more problems.

Replacement For Obamacare: A Free Market We NEVER Had

Today, healthcare is the primary driver of debt in America, both in households and our governments. As of 2016, the cost of healthcare was an average of $25,000 per household – three times what it was in 2001, and nearly double the amount spent before the Affordable Care Act was passed with the promise to lower it. This figure is expected to increase at least 40% by 2023.

Now that the repeal/replace effort has stalled in the US Senate for a lack of votes (the Democrats had 60 in 2010, the GOP only has 52 in 2017), Democrats are pushing a “fix” for Obamacare, acknowledging it’s flawed, but saying we need to make it work.

The problem isn’t that its flawed – the premise is what’s flawed: government-run industries don’t work well. You cannot fix an inherently flawed idea. You can only make the pain of it’s implementation more bearable. Is that what we want?

When someone starts to talk about other developed nations having universal care, stop them. We aren’t them, and we shouldn’t be. England has universal care. And they’re not ecstatic with theirs either (watch video):

All attempts to fix the access problem in the last 50 years have led to higher costs, less transparency, limited choice and bigger government. They have made the original problems worse, while creating new ones.

A couple of realities need to be more widely understood before we continue:

90% of Americans have health insurance. Only about 4% are on an ACA-affected plan. However, the law is much bigger of a problem than the 4% that are on it, because it’s merits affect the entire health industry.

Also, any repeal will not cause 16, 20 or 22 million to “lose their insurance.” 12 million already choose to just pay the fine. The other several million in those figures are estimates of future eligible users, assuming 100% of them sign up. Which we know isn’t going to happen. Regardless, not signing up for a bad program is not “losing” something you think they’ll have someday.

For years, all 50 states had a patchwork of half-tries, mostly failures. So, progressives have attempted to use the power of Washington, D.C. to implement one-time fix-alls. But, we have a federal government, which means the power is “federated,” or distributed among all 50 states, and at multiple levels of its own. This is an asset, not a liability. Whatever changes D.C. makes, it should do so with the intention of giving the most freedom to individuals, and the states they live in. As a nation, our government’s only role is to guarantee as much free movement as possible, so long as it does not inhibit someone else’s.

THE MOMENT HAS COME

So, here we are, with over 30 state governments, the House, the Senate and (presumably) the Presidency in Republican hands for the first extended time in 86 years. What will we do?

Speaker Paul Ryan (R-WI) had the dreadful challenge of herding a box of disjointed, uncoordinated caucuses across the House floor to come up with a tangible replacement for the ACA. The AHCA, despite lots of drama, was passed in May 2017. Ironically, those who battled that plan as not conservative enough were mad in July 2017 at the Senate “skinny bill” not passing – an arguably nascent bill that didn’t repeal much at all, save for one mandate and a few taxes.

The Republican conference assembled some of their ideas in The Better Way agenda revealed last June, while others have introduced ideas like tax equality, medicare reforms and portability through articles and books. Seven years ago, during the debate over passing the ACA bill, Whole Foods founder and CEO, John Mackey published a short list of fixes he saw as an alternative that was both market-based and a smaller government solution than the ACA. This op-ed contained most of the reforms we should have sought. But of course, Democrats got their bill passed by one vote, and these changes became impossible. Until now.

FIRST THINGS FIRST

First, any replacement needs to move the opposite direction of the ACA, and adhere to the constitution. The Supreme Court issued one of its most convoluted, mistaken rulings in allowing the ACA bills to stand in 2012, and again in 2015. The American people responded immediately to the bill’s passage by electing anyone who vowed to repeal it. And now, seven years later, if the GOP fails, it will be generational suicide for the party. Since we only have 52 votes in the Senate, we need to make incremental change, but change nonetheless.

Secondly, it should encourage free commerce, not force it.

Thirdly, it must allow the market to decide how to best deliver its product, not be managed by policymakers. Too much to ask in D.C., I know.

Conservatives want everyone to be able to have cheap, fair and transparent programs through the private market. Government involvement inflates costs. Truly free markets always decrease them.

This is the replacement plan that should be passed sometime in the coming year (state reforms in parentheses):

TRANSPARENCY

Require all multi-state health providers itemize their costs and provide publications of those costs to customers. This is simple good-faith business practice, and will lead to true competition. The status quo amounts to antitrust violations, as providers and insurers can hide the majority of costs, and refuse to itemize health care products and services, because of a convoluted system that is more socialist than free market. This problem preceded the ACA, and should have been resolved before simply changing who pays for expensive care. This is not traditionally a constitutional role, but is supported by the 14th amendment, which protects of the right of equal protection in state-based truth-in-selling laws. This reform could also be enacted on the state level, if necessary.

NATIONAL PORTABILITY

Forcing freedom of movement in a market across state lines is the very definition of “interstate commerce,” as called for by Article I, Section 8, Clause 3 of the Constitution. We should allow people to buy health plans wherever they reside, usable at any hospital network, anywhere. Even now, each state limits this by having their own rules that go above and beyond federal rules. Insurance programs plan accordingly. States should no longer force buyers to comply with arcane laws, forcing them to buy state-only plans. If federal plans pass muster, they should be used anywhere. And frankly, any state plans should be used anywhere as well. Before the ACA, more than 1,500 plans existed across all states, but only a few dozen ever competed against each other at any time.

HANDCUFF THE FDA

The insurance industry only averages 2.2% profit, but the pharmaceutical industry averages nearly 20%. There’s nothing wrong with profit in a free market, but when companies take advantage of virtual monopolies or manipulated markets like our own to raise prices, I have a problem with that. There’s a reason other countries have drug prices at a fraction of our own, and it’s because they allow freedom in those markets, and competition. The FDA has created a virtual cabal in the drug industry, in the name of protection. One of the efforts to change the status quo, Right to Try, is moving state-to-state. It’s a good start, but it cannot stop there. The war against government control needs to allow the all-of-the-above approach to go national. Fighting this is harder than tort reform, but the payoff is greater than perhaps any other reform we could pursue.

TAX EQUALITY

Equalize the tax laws, so private, public and employer-provided plans receive the same tax credits and incentives. Ideally, the tax laws should be evened out entirely, and all incentives targeting market patterns removed. Manipulation of the market is the opposite of a “free market,” and is not much better than the manipulations that created the pre-ACA healthcare crisis. But, in the very least, allowing people to purchase health care products, services or insurance should be made a tax deduction on federal taxes for now. If states can be encouraged to do the same, this will create true balance in the market, and encourage innovation among providers and insurers.

BLOCK GRANTS, NO STRINGS

Any federal role in healthcare is unconstitutional, but the runaround this has been federal officials motivating states to alter policy by tying strings around badly-needed revenue to support state medicare/medicaid programs. As a step toward shrinking the size and interference of the federal government, all monies should be block granted to states without conditions. If state medical programs are below the national average, they should be weaned off federal funding altogether, and their federal tax burden lowered accordingly.

REPEAL COVERAGE MANDATES (federal/state)

50 states have a patchwork of requirements on health insurers, and it leads to some states having cheaper plans than others, despite similar demographics, geography, conditions, etc. While the federal government has no authority to outlaw state mandates, it can require that states allow plans that are assembled the way creative insurers, providers and consumers want them to be. Again, according to the Constitution, the federal government has the power to regulate interstate commerce – that is, to “make regular,” or encourage freedom of movement. Furthermore, the 14th amendment assures that each state must honor contracts, agreements and personal ownership across state lines. Other popular federal mandates, like the 26-and-under child coverage and pre-existing conditions waiver can and should repealed and met by states on their level, and by a radically cheaper market.

REPEAL BANS ON INNOVATIVE SERVICES (state)

Currently, most states outlaw or discourage any creative health provision program, other than the traditional insurance plans we know and hate to love. In 2007, Washington state passed a law encouraging medical practices to foster innovative programs to provide care and services to patients. One company, Qlianc Medical Management initially charged $65/mo for unlimited access to services and personnel. The business model was sound – the average doctor was getting $200-250 per patient, per year, but the membership program guaranteed triple the revenue. North Carolina, and other states have similar direct-pay industries with monthly fees, but most other states have treated such programs as full health insurance plans, with all their regulation, mandates and minimum pricing rules. This kills a free market, and drives cost higher by eliminating innovation and competition. As a result, the closest you can get in some areas of the country are faith-based cost sharing programs like CHM, which spreads the cost of members’ health bills across the network.

But, with the suggestions above, the immense cost saving potential means that states should to be encouraged to promote these businesses. If these companies wish to provide services across state lines, the federal government can encourage this kind of innovation.

TORT REFORM (state)

The dreaded term brings chills to the spine of lobbyists, and plumes of flame in the eyes of legal associations nationwide. While it’s a major factor in the cost of healthcare, it’s not always seen as the most important. Many authors have furiously devised studies, and articles to broadcast those studies about how tort reform aims for a problem that doesn’t exist. But, those studies are based on false premises, and use convenient numbers that ignore the real factors that affect quality and cost of healthcare. There are just as many studies that use real numbers that effect the cost and experience of consumers. They reveal positive effects of tort reform. One in 14 doctors face medical malpractice lawsuits every year. In higher risk industries, like heart surgery and neurology, the threat is higher.

The average doctor pays $30,000 in malpractice insurance, some as high as $300,000. Each year, malpractice losses cost the industry an average of $20 billion, or an average of 4% of a practice’s revenue. This clearly has an efficiency and cost effect on care. After 10 years in Texas, tort reform resulted in a roughly 50% drop in malpractice lawsuits, and an influx of doctors and medical practices applying to work in the state. Today, malpractice insurance is up to 40% cheaper than it was in 2003. Before 2005, the American Medical Association listed Texas as a “state in crisis,” but removed the designation just two years after tort reform was passed. Furthermore, access has increased as the number of practicing doctors in the state has grown at twice the annual rate of population growth, and the cost of healthcare has grown by only 25% of the national average.

Now, faith-based hospitals have increased their charity care pools by hundreds of millions of dollars in that state, providing care to people who cannot afford even the cheapest plans that result from a truly free market. This is what happens when freedom lives without fear or manipulation.

As these reforms are enacted, a tapered repeal should be implemented that allows current enrollees to retain their coverage for a number of years, depending on their income level, with the goal of eventually motivating all existing members to find cheaper, better access elsewhere as the newer, freer market takes hold. Meanwhile, states will be able to supplement their own healthcare systems with the increased block grants if their rates of privately insured decrease as a result of these changes. Eventually, Obamacare will become a distant memory, because it’s dependents will no longer need it.

 

FREEDOM ISN’T THE PROBLEM, MICROMANAGEMENT IS

Insurers have never been the main problem, but dependency upon them is. Furthermore, neither is profit. Only 18% of hospitals are for-profit, and the average profit margin at the largest insurance providers is approximately 8%. The problem is cost and access, which are affected by the lack of transparency, portability or true competition. Profit motivates action, and is not inherently evil. It should be encouraged, because it leads to innovation and improvement in every other industry that exists.

The costs of malpractice abuse and over-regulation of the healthcare market have not been subject to the market forces that free consumers bring. Even before the ACA, the industry did not have true competition, accountability, or the efficiency that comes from it, because it was hidden. Critics disparage the “free market” of healthcare, but was it ever truly “free?” Some people want this area of their lives to have no stress – just confidence they’ll always have healthcare, regardless of what that really means in the end. As conservatives, we believe the tradeoff is worth it, if you do it right. No half-measures, somewhat-free markets, or HMOs.

We need to do a better job of educating the public on why a free market works better. Too many believe we want to return to the system we had before, with all it’s flaws and abusive aspects. We don’t want to go back to that… we want to have a truly free market for the first time in nearly two generations. It requires simple, consistent messaging to persuade the public.

If we enact the reforms above, keep it simple, constitutional, and allow states to do the rest as their people need it, the cost of healthcare will decrease; the number of healthcare providers will increase; and everyone, everywhere will be able to find healthcare anywhere they go, and at a cost that is not more than they can bear. When health CARE costs go down, health INSURANCE costs go down as well.

Remember, healthcare is not a right. Rather, the ability to pursue a happy, healthy life, with liberty and happiness IS one. And it’s time the government accepts that it’s only role is to promote liberty, not manage it. Can we convince our neighbors of the same?