A Repeal and Replace Plan That Works

For more than six years, the one constant in every single Republican campaign was a promise to repeal Obamacare. Presidential candidates said it. Prospective senators and congressmen said it. Gubernatorial candidates, too, said that if elected they would do everything in their power to fight the Affordable Care Act’s many encroachments on state power. Given the chance, even Republican mayors and county councilmen would loudly proclaim how opposed they were to Obama’s signature legislative achievement.

In return, Republicans were given the House in 2010. They were given the Senate in 2014, and, against all odds, the White House in 2016. And what do they do with their newfound power to finally repeal and replace Obamacare, a day many believed would never come?

They introduce the American Health Care Act, a bill whose first sentence begins, “the Patient Protection and Affordable Care Act… is amended.” A fitting summary of the contents of the bill.

The individual mandate is repealed—and replaced with a new mandate, a requirement for insurance companies to charge extra those who allow their insurance to lapse. Such a measure is just more government overreach, and of doubtful constitutionality.

Medicaid is reformed—but not until 2020. And those reforms are clumsy and unnecessarily complicated, far short of the simple block grant program that many have argued for.

Some taxes are repealed—but others are kept, including the ridiculous Cadillac tax on “deluxe” health plans.

And the Independent Payment Advisory Boards, or “death panels”, remain in place.

Without a doubt, this is better than the current Obamacare framework. But it should not be enough for Congress to merely pass a bill where the best thing that can be said about it is that it is better than a disaster. We can and must do better.

The first step should be to repeal Obamacare outright. Ideally, this would consist of a one-sentence bill: “The Patient Protection and Affordable Care Act is hereby repealed.” Unfortunately, such a bill would have been feasible only in the early years following the ACA’s initial passage. Measures have already been implemented that cannot be easily taken away without disrupting the lives of millions.

Instead, Congress can merely repeal the individual and employer mandates, taxes, and all other assorted regulations, along with halting all further Medicaid expansion. Repeal, too, the requirement that insurance companies must allow young adults to stay on their parents’ plans until age 26. Whether there would be some kind of staggered end to this provision, or a grandfather clause, could be up for discussion and debate.

Don’t worry about anything else in the repeal legislation. Stop Medicaid expansion, but don’t reform the program just yet. Don’t worry about the familiar cries of “But what will you replace it with?” The American health care system circa 2009 may not have been ideal, but there weren’t hordes of starving people dying in the streets. And the gap between the end of Obamacare and the beginning of a new kind of health care system need not be long, because Republicans could already be working on a replacement while the repeal bill was passed and implemented.

That replacement bill, that vision of a new health care system, would be radically different from both Obamacare and House leadership’s own proposal. It would put the marketplace and the individual first by offering true choice and competition, and eliminating all government mandates. It would dramatically expand Health Savings Accounts, far more than the AHCA proposes, and allow insurance companies to compete across state lines. It would address badly-needed tort reform head on. All of these are classical GOP beliefs on health care policy that, somewhat surprisingly, get little mention in the tepid proposal put forth by Congressional leadership.

Yes, Speaker Ryan and the rest say that additional legislation will be forthcoming, once the AHCA has been passed. But given the milquetoast nature of that proposal, coupled with leadership’s long history of proclaiming their intent to “fight another day”, how likely does it seem that radical health care reform legislation is imminent?

Because that is exactly what we need: radical reform. Reform that places individual choice, not government coercion, at the forefront of the health care policy debate. Accordingly, the American Health Care Act should represent the opening salvo of negotiations, not a final product.