Rand Paul's Obamacare repeal plan gets there

Republican leadership's plans for the Obamacare repeal were recently leaked, though "repeal" is perhaps too strong a word. "Tweaks" more accurately describes the work of Speaker of the House Paul Ryan and other House Republicans. It does not go back to ground zero, where this disaster began. Instead, the plan is to go for "Obamacare Lite." It's simply a different version of Obamacare — a Republican version of Obamacare. It's how President Obama himself might have done it.

Senate Majority Leader Mitch McConnell, R-Ky., has said, "The best interest of the country would be achieved by pulling out Obamacare, root and branch." More recently, Ryan reiterated that the House plans to repeal Obamacare, adding that "you can't" repair "a collapsing law." Ryan has also said that repeal of Obamacare is entitlement reform.

Like Obamacare, the plan has an individual mandate through fines for those who don't keep continuous coverage. Like Obamacare, it has a Cadillac tax, which will eventually impact most insurance plans. Most egregiously, however, the bill would create a new entitlement through refundable tax credits. Republicans appear to be "reforming" an entitlement by "replacing" it with ... another entitlement.

This is not repeal. It's tinkering around the edges, and it's failing to keep campaign promises. A truly conservative agenda for repealing Obamacare is getting rid of it — all of it — and going back to 2009 to enact various improvements to the insurance market.

We can address regulations that increase costs by returning regulation of the health insurance industry to the states. Why should the federal government not negotiate Medicare Part D benefits to lower prices? Why can't health savings accounts be used to buy health insurance?

Conservative grassroots activists stand 100 percent behind the efforts of Sens. Rand Paul, R-Ky., Mike Lee, R-Utah, Ted Cruz, R-Texas, and members of the House Freedom Caucus and the Republican Study Committee to repeal Obamacare and replace it with a patient-centered alternative. Specifically, we endorse the Obamacare Replacement Act, introduced by Paul and Rep. Mark Sanford, R-S.C.

This bill provides a complete reworking of our healthcare system, focusing on real patient-centered alternatives. It starts by repealing every word of Obamacare and its regulations. It also legalizes affordable health insurance coverage, expands the use of HSAs to include buying health insurance, and equalizes the tax treatment for insurance so that individuals receive the same tax deduction that employers receive to help pay for coverage.

Additionally, the bill allows organizations and non-profits to band together and negotiate lower prices for health plans in a group market. It gives patients with pre-existing conditions a two-year open enrollment period under which they can obtain coverage.

Lastly, the Paul-Sanford plan repeals Medicaid expansion. Two-thirds of people who received Medicaid coverage after Obamacare were already eligible for it prior to expansion. The bill allows states to apply for waivers to set up Medicaid programs that best fit their needs. All these steps will increase choices, increase ways to pay, and increase portability, the lack of which exacerbates the problem of pre-existing conditions. Above all, it lets individuals have the freedom to buy coverage that suits them, not the dictates of bureaucrats in Washington.

However, even if this legislation passes, it is not the end of the story. There is still more work to do to make the market work more efficiently and provide genuinely affordable healthcare. Block grants for Medicaid, state innovation grants, and federally-funded high-risk pools — there are plenty of conservative ways to restore control of healthcare to the patient, if Republicans have the boldness to seize the opportunity.

At the very least, however, they must rework the current plan. It doesn't get us back to square one. It takes the rare chance to deliver on campaign promises made for the better part of a decade and it squanders them. Given a chance like this, Americans deserve a better plan than this. It's up to Republicans to give it to them — and soon.

Adam Brandon (@adam_brandon) is a contributor to the Washington Examiner's Beltway Confidential blog. He is president and CEO of FreedomWorks.

First, my point #10 refers to (for example) allowing Aetna Healthcare of Delaware to merge with Aetna Healthcare of Connecticut and Aetna Healthcare of Utah and so on. Paperwork and overhead costs would be reduced.

Second, I think that you and I disagree about the likelihood that ObamaCare could actually be repealed without simultaneously providing a “replacement”.

Since I think that stand-alone “Repeal” is DOA, I want to focus on providing conditions that would encourage free-market entrepreneurs to provide a variety of health-care insurance plans, designed to appeal to many different types of consumers.

IMHO, if the cost of individual, “portable” healthcare plans is reduced by making their premiums tax-deductible, then employer-provided healthcare plans would become less attractive.

If keeping “...the wealthiest...” from getting the full benefit of such tax deductions is desired, then a “cap” to limit deductions is a simple solution.

Congress has said they are working on a simultaneous repeal and replace, including an ability to sell across state lines. If you are now proposing that your plan is to do the two simultaneously, you’re really agreeing with Congress.

And even if employer-provided plans were less appealing, you would have captured the market distortion from them in your own, more direct, government subsidies. That is the major point I think you are missing. How do you think college costs grew so quickly over the past 30 years?

What we most just need to do is to get the government distortions out of the market, such that, for example, people only purchase insurance for catastrophic coverage. But in practicality vested interests, including corporate and union lobbying of Congress, make that unlikely. Thus, Congress is doing the usual and replacing with an Obamacare-lite that will continue to make the market fail—just more slowly than the Democrat approach.

Replacing Obama-care should be temporary legislation IMHO, not something that lingers. DocFix for example, forgiveness of medical debt if the doctor accepts a generous percenatage from the govt — that’s an annual bill that doctors had learned to count on.

... but ...

Then we can drive wedge issues — grossly self-inflicted disabilities should not be funded in any way.

For example, some goon shoots at a policeman who shoots back. The criminal is hospitalized and crippled for life. Of course we should keep him alive until he is found guillty. But after found guilty?

Since the cripple is hardly a danger in public, why feed him in prison?

Judge could rule ‘time served’, and out in the street the creep goes. NO government aid of ANY kind. It was an incredibly GROSS [and evil] way to get himself crippled. No SS. No hospital — just private charity.

How many people would agree with that?

We need to get the government out of healthcare completely to bring down the costs. But of course we’ve got people who have paid a lifetime into Medicare and expect to get that coverage—so that should be the last to go.

There is zero reason for the federal government to be involved in healthcare at all—and it should transition out of Medicaid.

However, we’re not going to let the truly needy go uncared for—however they got there. (E.g., most most costly Medicaid costs are tied to obesity.) What we need to do is minimize the truly needy with free market reforms and incentives that make more people able to pay for it themselves.

Yes, I know what you’re referring to, but that actually isn’t a big saver (most insurance companies are already pretty big at the state level) and it ignores the fundamental drivers destroying the market.

Making plans “tax deductible” does three bad things—it simply shifts the costs onto others, it provides an incentive for every last thing (as opposed to just catastrophic care) to be covered in a third-party system, and it encourages higher costs and overuse.

What we’ve got and what people who are actually being subjected to that they find so odious is that Obamacare as it stands is tantamount to old catastrophic coverage with a very high deductible but they’re not getting anything in return for that very high deductible, it’s still a very expensive policy, and they’re forced under penalty of law and financial penalty to buy this inferior policy. That’s the problem in a nutshell for people who are in the difficult position of actually having to deal with this boondoggle on the exchange. Arguing back and forth over fine points of political principal is going to be lost on most. Solve the problem of being able to have decent medical insurance at a price that is acceptable. If that involves government at some level, and I don’t see how it can’t with preexisting conditions and indigent care, then so be it. The Ryan bill does not solve this it actually increases the penalty, but it’s not forced by law currently even though the door appears to remain open. On principal the Paul bill is much more appealing, however if principal does not get the above problem for actual policy holders in the exchange solved, it will be just as hated and just as much of a failure as Obamacare but hung around the necks of conservatives.

“But of course we’ve got people who have paid a lifetime into Medicare and expect to get that coverage—so that should be the last to go.”

That is very realistic and practical.

We need a phase-out plan that offers soft landings before we shift completely to private charities and personal accountability. IMHO — the most concrete way to achieve that is via a constitutional amendment. Otherwise, they will keep tinkering with it.

BTW — before we can truly improve healthcare we need to straighten up peoples’ thinking about it.

Not merely education, but I’ve worked out a ‘mandatory debate’ plan that will force key public figures into fair time / no moderator debates with each other.

Not just healthcare but all issues.

Making healthcare insurance costs “deductible” for corporations, but not for individuals, is a ancient distortion, that IIRC dates back to WWII.

True, that distortion could be corrected by repealing that tax deductibility.

Or it could be corrected by providing tax credits to individuals to “balance” the existing corporate subsidy.

Which of those two options has the better chance of being passed now, in your opinion?

Making healthcare insurance costs “deductible” for corporations, but not for individuals, is a ancient distortion, that IIRC dates back to WWII.

True, that distortion could be corrected by repealing that tax deductibility.

Or it could be corrected by providing tax credits to individuals to “balance” the existing corporate subsidy.

Which of those two options has the better chance of being passed now, in your opinion?

RIght—that’s why we are headed to tax credits (even worse than tax deductibility). But though it evens it out, that doesn’t take the distortion out of the system—it just increases the over distortion. All the wrong incentives in an area that government shouldn’t be involved in at all.

If we had serious statesmen, they would link the tax cuts to the healthcare reform, so that those newly getting taxed on their health plans would at least have it offset by the cuts.

But they are all cowards and nobody wants to bother making the case that should be made to the voters.

You said: “...IF we had serious statesmen...” Aye! That’s the problem, isn’t it?

Before the next election, let’s “primary-out” RINOs like Lindsay Graham and Jeff Flake and in that election, let’s cut the number of Democrats “serving” in Congress in half.

After we do that, our conservative majorities can seriously begin to “drain the swamp”.

Even so, let’s remember that the Pontine Marshes weren’t drained in a day...

Yes, the difficulty is getting a gain in the House next time around, rather than a loss. Ryan, etc., seem intent on grinding down to useless or delaying beyond the useful any positive legislation Trump really needs to do. (Real Obamacare repeal and tax cuts, to start.)

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.