Posted on 03/24/2017 12:03:20 PM PDT by NobleFree
At some point, the House is expected to vote on the American Health Care Act (H.R. 1628), which would partially repeal and replace various components of Obamacare. The proposed legislation repeals a number of Obamacare provisions and contains several notable policy reforms, but the most important part of the AHCA is what it fails to include: a repeal of the regulatory architecture of Obamacare that is responsible for the rising cost of health care.
Title I of the Patient Protection and Affordable Care Act (i.e., Obamacare) lays out a number of health insurance mandates and regulations that make up the regulatory architecture of Obamacare including guaranteed issue, community rating, essential health benefits, and actuarial value, among others. While the AHCA does repeal actuarial value and partially addresses community rating by moving the age rating ratio that Obamacare imposes from 3:1 to 5:1, the bill falls far short of comprehensively addressing the overall regulatory framework of Obamacare.
Obamacare’s creators designed this regulatory framework with the intent to take control of private health insurance plans and convert them into a highly regulated, quasi-public utility. As one of the law’s supporters explained back in 2010, Obamacare’s design “transforms health insurance into a public accommodation,” and turns private health insurance into “a regulated industry … that, in its restructured form, will therefore take on certain characteristics of a public utility.” It strains credibility to characterize this bill as repealing Obamacare when the mechanisms for the federal government’s takeover of health care remain firmly in place.
Taken together, these mandates and regulations restrict consumer choice and drive up the cost of health care premiums by a national average of 44.5 to 68 percent. As Heritage Foundation Senior Policy Analyst in Simulations Drew Gonshorowski writes:
“Overall, accounting for gender, age, and the relative proportions of all those groups, Americans are paying 44.5-68 percent more in premiums owing just to Title I regulations. That number is even higher when factoring all the other adverse effects of Obamacare. Obamacare’s Title I regulations bid up the price of premiums drastically for many Americans. While the current House bill begins to repeal Obamacare, it does not go far enough, as many of the most damaging regulations are left in place. Alleviating this pain should be strongly considered at every step of the process.”
The AHCA would also subsidize that regulatory framework through new refundable tax credits aimed to help individuals buy their own health care plans – plans that will remain highly regulated and overly expensive. There has already been political pressure to increase those credits, and that pressure will increase so long as premiums remain high.
As Heritage Foundation Senior Research Fellow in Health Policy Studies Edmund F. Haislmaier describes:
“The key problem with the draft House health care bill is that it fails to correct the features of Obamacare that drove up health insurance costs. Instead, it mainly tweaks Obamacare’s financing and subsidy structure. Basically, the bill focuses on protecting those who gained subsidized coverage through the law’s exchange subsidies and Medicaid expansion, while failing to correct Obamacare’s misguided insurance regulations that drove up premiums for Americans buying coverage without government subsidies.”
Yuval Levin, editor of National Affairs, explains that the AHCA is “fundamentally different” from previous Republican health care proposals, including the bill introduced by now-Secretary Tom Price, “because it functions within the core insurance rules established by Obamacare, which means it can’t really achieve most of the key aims of the conservative reforms it is modeled on.”
Lawmakers cannot preserve Obamacare’s regulatory structure and claim to have repealed the law. Without including the repeal of these regulations in the AHCA, congressional Republicans will have failed to keep their seven-year old promise to fully repeal Obamacare and health insurance costs will likely continue to increase leading up to the 2018 elections.
House Republican Leadership claims the AHCA is only phase one of a three-part plan to repeal and replace Obamacare. In phase two, Human Health and Services (HHS) Secretary Tom Price will take action to address the Obamacare insurance mandates and regulations. In phase three, Republicans will pass any additional reforms they failed to achieve in phase one and two. Unfortunately it isn’t that simple. All executive action in phase two is limited, temporary, and will likely face serious legal challenges. All legislative action in phase three will require 60 votes in the Senate, including eight Democrat votes, a nearly insurmountable obstacle for Republicans to overcome.
Thankfully, Republicans in Congress have the legislative tool necessary – budget reconciliation – to fully repeal Obamacare’s regulations and avoid the political and policy complications contained within phase two and three. Some Republicans have argued Congress cannot repeal Obamacare’s insurance mandates and regulations contained in Title I through budget reconciliation because it does not have a clear budgetary impact. This is somewhat surprising considering the AHCA includes some regulatory changes while leaving others out. Regardless, this argument ignores the reality that Obamacare’s regulatory architecture imposes significant costs on taxpayers and is inseparable from the rest of the law. A January 2017 Congressional Budget Office (CBO) report left little doubt that Obamacare’s regulatory regime has budget implications.
As one former Senate staffer wrote:
“To argue that their budgetary impact is merely incidental to the rest of the law is absurd on its face. Even the Obama administration made this very argument before the Supreme Court in King v. Burwell, arguing forcefully that the regulations are inseparable from the rest of the law. Predicated on that alone, Congress has a case that full repeal through budget reconciliation is viable.”
The Wall Street Journal editorial board describes the two managers’ amendments released Monday night as “mostly modest,” which is true because they do nothing to repeal the regulatory architecture of Obamacare.
Republicans promised to fully repeal Obamacare, campaigned on full repeal since 2010, and voted more than 60 times to repeal parts or all of the disastrous health care law. The American people rewarded Republicans for their promise to repeal Obamacare by giving them a united government for the first time in more than a decade. An unwillingness to pursue repeal of Obamacare’s Title I insurance regulations through reconciliation based on a narrow interpretation of budget rules is not acceptable.
Unless repeal of Obamacare’s regulatory regime is included in the AHCA, the bill deserves to be defeated because it would leave the architecture of Obamacare in place and ensure health insurance premiums remain far too high.
Then-Representative Mike Pence’s description of his 2003 vote against the Bush-era prescription drug program resonates still today: “House conservatives faced a difficult choice: oppose the president we love, or support the expansion of the big government we hate.” Voting against a leadership-crafted bill was “not a sign of disloyalty, but of true loyalty to principle,” Pence explained at the time. That same principle remains true today.
Heritage Action opposes H.R. 1628 and will include it as a key vote on our legislative scorecard.
Not only no, but hell no!
Why doesn’t Ryan just pass a straight repeal through the House and then send it to the Senate and let the Senate amend as necessary to get it through the Senate? Any Senate amendments would require that it go back to the House so the House would have the final say.
What am I missing?
I don’t believe RINOs will change giving healthcare to illegals after this bill passes
This is not Trump’s loss.
It is Ryan’s loss.
It is the GOPe loss.
We won.
Trump will come up with something else that complies with his promises.
When this vote fails we will KNOW who stabbed us in the back and voted NO because Trump is demanding a roll call vote. We will see who the the quislings that are “Oh so much more conservative than everybody else” are. They will be exposed. They will not be able to hide behind a cancelled vote.
I left the Republican Party three years ago and these lying good for nothing POS have just reminded why I did. I WILL NEVER VOTE FOR ANOTHER REPUBLICAN AGAIN.
Nope, they just don’t like slop anymore than we do.
It is not a good bill.
It is 80-95% Obamacare.
What the hell are you folks smokin?
They need to have a vote on full repeal, win or lose.
If the bill passes as it is WE won’t SEE phase 2 or 3 that’s the problem!!!
Single payer is right where this is headed, with no health care savings accounts and no lowering of state borders for insurance.
This is 80-95% Obamacare. HELL NO to that.
The only circus is the three ring job that the GOPe, Ryan, and other RINOs pushed off on us in this devilish plan.
The Obamacare legislation was thousands of pages long.
This eliminated very little of that. Why do you folks not see that?
What am I missing?
Nothing. What RIyaNO is missing is principles and a spine.
“It is Ryan’s loss”
So you are will to sacrifice an outstanding agenda just to get at Ryan?
Forget Ryan, pass the bill to keep the ball rolling. Trump is doing everything we have been needing, don’t kick the ball out of bounds.
Sorry, I don’t get all the hate for Ryan.
Take any situation:
Good outcome - Yeah Trump!
Bad outcome - Ryan’s a Chump!
The quislings are those not even putting full repeal to a vote - and those pretending that cutting the taxes while leaving the expenses and regulations, as RINOcare does, is anything other than a disaster waiting to happen.
I have read and/or heard explained the long-winded, convoluted explanation (as in the cited article), about why it has to be done in three parts, a number of times now. The more I hear it, the more I come to the conclusion that the only thing missing is for Republicans to grow a pair and implement the nuclear option (aka the Reid option), and get rid of this stuff with a simple majority. But it seems that they’re all too afraid to stand up and say “we won” like Obama did, so instead they feel they have to resort to this parliamentary trickery, like they’re ashamed of repealing Obamacare. I’m pretty much disgusted with this Congress by now.
The President is a man of his word. We will see all three phases. If someone in Congress promises it, you are right. But Trump will make it happen. And that’s a fact!
The Obamacare legislation is thousands of pages long.
This changes very little of it.
Why can’t you get that through your head?
I don’t want 80-95% of Obamacare left over.
This is a terrible start and you should know it.
I am thankful that the Republicans held on to the Senate last year, RINOs and all. The alternative would have been Senate Majority Leader Chuckie Schumer blocking every single one of President Trump's cabinet and judicial appointments.
2016 was not the year for replacing RINOs with Democrats. 2018 is a totally different issue.
In 2018, far more Democrat Senate seats are up for election than Republican ones. While it would be nice for the Republicans to pick up a filibuster proof majority, it won't do a damned bit of good if it includes RINOs voting with the Democrats. It is worth replacing a few RINOs with Democrats if it means also replacing some RINOs with Conservatives.
Now is the time to be picking Republican Senators and Congresscritters to focus on throwing out in the primaries. How they vote on repealing Obamacare will be the first test for which ones are worth keeping and which ones need to be dumped.
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