In 2016, Republicans in Congress set the floor for what a repeal of Obamacare would look like in H.R. 3762, legislation that former President Barack Obama vetoed that included ending Medicaid expansion, premium subsidies, cost-sharing subsidies, the individual and employer mandates, reinsurance, risk corridors and risk-adjustment, and the taxes and spending from the health care law.
Unfortunately, at first blush, the legislation proposed by the House Ways and Means Committee and Energy and Commerce Committee does not meet that basic standard, leaving in place key parts of Obamacare while eliminating others.
To its credit, the bill does appear to zero out the tyranny of the individual and employer mandates. But Sen. Rand Paul (R-Ky.) contends that it replaces these penalties with another penalty that now must be paid directly to insurance companies if you drop coverage, which he said is “unconstitutional.”
But on things like Medicaid expansion, it only phases it out in 2020, and even then, in states that have expanded Medicaid, current beneficiaries will get to keep their federal matching funds, provided that they “do not have a break in eligibility for more than one month,” according to the section-by-section summary provided by the House Energy and Commerce Committee.
It even encourages further Medicaid expansion first by continuing to provide states with the option of doing so through the end of 2019, including the federal matching funds, and for states that don’t, they still get a carve-out — $2 billion a year for “safety net funding.”
The Cadillac tax is merely postponed until 2025.
The legislation appears to replace exchange plan subsidies with a regime of tax credits — the exchanges themselves remain in place. The plan also subsidizes a national, catastrophic-only insurance plan. These subsidies would sunset in 2020.
Leaving aside the issue of subsidies, surely, though there would be a national market for a catastrophic-only insurance plan, so one hopes that such an affordable option would be available even to those who do not qualify for the tax credits.
The cost-sharing subsidies are also repealed starting in 2020.
So, there’s good and bad from a limited government, free market perspective, but when the GOP campaigned in 2016 on repealing Obamacare, they did not say there would be exceptions to what they had just put on Obama’s desk to be vetoed.
Why can’t they just pass the bill they passed last year?
If it was good enough for Obama to veto, it should have been good enough for President Donald Trump to sign.
Instead, the American people are now being treated to what can only be called a partial repeal.
Other parts of the health care law that were unaddressed by the 2016 repeal legislation that Obama vetoed also remain in place, including leaving children on their parents plans until the age of 26, preexisting conditions and regulations for what insurance plans must cover — except for the catastrophic only plans, presumably.
All remain in place under the guise that they cannot be addressed via the reconciliation budget process and thus are untouchable given Senate rules otherwise requiring 60 votes to enact legislation.
That is why Americans for Limited Government President Rick Manning thinks Congress can do better, urging that “the foundation of the replacement of Obamacare has to be a complete return of health care to the states where it constitutionally belongs,” pointing to proposals such as the Texas Public Policy Forum have advocated.
Manning said if a change of budget or Senate rules is necessary to get a full repeal, then that is what, minimally, Congress ought to attempt.
“If this the best Congress can do to partially repeal Obamacare via reconciliation, then perhaps Congress should consider revising the rules on reconciliation, or if that is not feasible, then just do away with the filibuster. It’s ridiculous that fixing our nation’s health care system is restricted by old rules that only lock in place a broken status quo,” Manning concluded.