Yes, We Can Repeal Every Word of Obamacare

No more excuses.

As CR’s Daniel Horowitz has repeatedly warned, timid congressional GOP leaders have no intention of repealing Obamacare. Instead, they want to “fix” it—an impossible task.

But last Friday, they lost their last excuse for not repealing every word of the ill-conceived, destructive health care law.

Two new pieces of information change the equation dramatically.

The first offers unmistakable evidence that the Obamacare exchanges are collapsing, contrary to the Left’s “everything is working fine” narrative.

The second proves the Senate can repeal the law’s onerous insurance mandates (which are the heart and soul of Obamacare, and which are the number one driver of soaring insurance premiums) with only a simple majority, rather than a bipartisan supermajority—contrary to Republican leaders’ “can’t repeal the mandates” claim.

These two developments take the steam out of the bipartisan Beltway consensus in favor of essentially repackaging Obamacare.

More specifically:

On Friday the two-week-old Trump administration reported that:

  • Sign-ups at healthcare.gov, the federal exchange, have declined for the first time ever, by a sizable 400,000 persons in 2016—a four percent drop in one year.
  • The number of insurers participating in the federal exchange has dropped from 237 in early 2016 to just 167 now—an eye-popping 30 percent decline in one year.

Clearly, the S.S. Obamacare is taking on water, and quickly. The case for abandoning ship has never been stronger.

The second bit of news is even more game-changing. The Congressional Budget Office (CBO) confirmed what many of us have long suspected, namely, that the Senate can indeed repeal every word of Obamacare’s mandates and subsidies—including its onerous insurance mandates—with only a simple majority vote. Republicans can do it on their own. No Democrats needed.

To be clear, CBO did not issue a new announcement. Rather, it actually made the declaration more than a year ago, almost in passing, in a pair of wordy footnotes in a formal budget estimate — but hardly anybody noticed. No one really appreciated the full significance of the footnotes until last Friday, when a scholar at the libertarian-leaning Mercatus Center translated them from “budget-ese” into plain English.

In short, what CBO said is this. Obamacare’s onerous insurance mandates have a direct, non-trivial, non-incidental effect on federal spending and the deficit. Those adjectives are important. Under congressional budget rules, to be eligible for consideration via fast-track “budget reconciliation” procedures, a bill must meet all of those particular descriptions. A reconciliation bill cannot be stopped by a filibuster in the Senate and requires only a simple majority, rather than three-fifths, for passage. So CBO’s words mean every word of Obamacare can be repealed on a fast-track, party-line basis.

Republicans have run out of excuses.

Since taking control of Washington last month, GOP leaders have been slow-walking—and soft-peddling—repeal. Instead of “replacing” Obamacare, they now want to “repair” the damage it has done, over a period of years—which, one suspects, is their way of saying they simply want to “repair” the law and move on.

That, of course, would be a fool’s errand. As a practical matter, repeal is an “all or nothing” proposition. And repair of this crazy scheme is not possible. As Yoda would say: Repeal, or repeal not. There is no “repair.”

And of course, “repairing” Obamacare is not at all what President Trump ran on. He ran on “completely” repealing it and replacing it with “something terrific.”

Speaking of which—what exactly is this “something terrific” our president speaks of?

Hard to say. He hasn’t been clear about that.

But if we stick to our principles, we will make sure “something terrific” does not include such “constructive Republican alternative proposals” as:

  • A federal ban on preexisting-conditions exclusions.
  • A federal mandate to let adults stay on their parents’ health plan till they’re 26.
  • Federal medical malpractice reforms that overwrite state civil-justice rules.

Such “reforms” may be popular, but they are unconstitutional, unnecessary, and counterproductive. The power to regulate health insurance (and the resolution of health-care disputes) is reserved, under the Tenth Amendment, to the states.

On the other side of the coin, “something terrific” should include:

  • The return of health insurance regulatory powers back to the states.
  • The elimination or devolution to the states of federal health insurance subsidies (for example, by way of transitional block grants).
  • Greatly expanded Health Savings Accounts (HSAs).
  • Medicaid and Medicare reforms, to make those massive entitlements fiscally sustainable, voluntary for individuals, and ultimately transferrable back to the states.
  • Sensible reforms to equalize the tax treatment of health insurance, so consumers are no longer penalized when they try to obtain good, portable health coverage outside the workplace.

Beyond that, Washington should do nothing—except get out of the way.

The three broad principles of conservative health reform should be:

  1. The states, not the feds, are the proper regulators.
  2. Consumers, not bureaucrats, are the proper sovereigns.
  3. Lower medical costs, not “universal coverage,” is the proper goal.

The tragedy of Obamacare is that it wrecked the world’s best health care system to help fewer than 500,000 Americans (less than one percent of the U.S. population) who have a prohibitively costly pre-existing medical condition.

And despite the Left’s claims, we did in fact have “universal coverage” before Obamacare, in a practical sense. All Americans had access to medical care: 85 percent of them via health insurance, the remaining 15 percent via charity clinics and the emergency room. People did not “die on the sidewalk.”

Was it a perfect system? Obviously not. Did its flaws justify a federal takeover? No! All we needed were a few modest tweaks to help the tiny minority with pre-existing conditions, and a few commonsense reforms (mostly repeals and reductions) of existing government subsidies and regulations.

In other words, a state-regulated, consumer-driven system—not a massive Washington bureaucracy. Freedom, not coercion.

The latest developments make it clear: Republicans are now officially out of excuses.

They can and must repeal Obamacare—every word of it.

Dean Clancy, a health policy expert and tea party activist, has served as a senior budget official in the White House and Congress. Follow him at deanclancy.com or on twitter @deanclancy.


[Originally published at Conservative Review, February 6, 2017. Republished at deanclancy.com.]


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