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.
I like that idea.
I’m not sure he has Obamacare in mind, other than passing Ryancare to augment it or whatever.
This was a disaster for Ryan and the GOPe.
Colossal failure...
Obamacare Repeal And Replace Is A Tax Cut Getting Bigger All The Time
...”Some will call this part, especially, “Obamacare lite.” That would be irresponsible. It’s true that Obamacare has a tax credit, and the replacement plan will also have a tax credit. But this tax credit works very differently, is much more likely to succeed, and will prove to be far more usable and popular. Obamacare’s income-based tax credit encourages “job lock” and penalizes work. It has failed miserably, as evidenced by the implosion of Obamacare across the board.
Besides, conservatives have had a near consensus for decades now that this type of tax credit is the way to go for people who are not able to get health insurance in the two big ways we provide it in this country—via your job or via the government. There is no other practical way—outside of straight-up welfare—to get health insurance to people who can’t get it anywhere else. It’s this or nothing.”
Your correct, Ryan is going to have ‘remarks’ at 4:00 P.M. wonder if he’s going to try and pin this on President Trump, all I have to say is, he better not:
“I will personally get on my 3 turbo broom and fly back there and knock that punk on his butt”...
I think I made myself very clear, young lady!
OH YEAH, what are you going to do about it???
But now when all the insurance companies pull out of ObamaCare it still is Obama/Pelosi/Ried’s failure.
2018 GOP will have to go to their voters to explain why Obamacare still law of land
Without cutting expenditures there can be no true tax cut - only a tax shift to future generations.
Yeeeep!
I’ll be lucky if I live to be 60. Guess that’s what they want.
“In one stunning defection Friday, House Appropriations Committee Chairman Rodney Frelinghuysen (R-N.J.) announced at midday that the health care bill is “currently unacceptable” and that changes made late Thursday to placate conservatives “raise serious coverage and cost issues.””
“You want to score a touchdown, but sometimes, on the fourth down, you kick a field goal,” said Rep. Joe Barton (R-Tex.), the longest-serving member of Congress in the Freedom Caucus. “The choice is yes or no. I’m not going to vote no and keep Obamacare. That’d be a stupid damn vote.”
Rep. Bradley Byrne (R-Ala.), who planned to vote for the legislation, said that Friday would have been the “first big vote in the presidency of Donald Trump. I think it’s a statement, not just about him and the administration, but about the Republican Party and where we’re headed.”
“So much about political power is about perception. And if the perception is that you can’t get your first big initiative done, then that hurts the perceptions down the road about your ability to get other big things done,” Byrne said in an interview before the decision.
So, no one is talking to each other anymore? That reflects poor leadership on Ryan’s part. RYAN NEEDS TO GO!
I think that is really the biggest issue here. I can fully understand the need to do this in pieces, but what can we point to showing the Republicans will honor that promise? Anyone who actually believes we will see phase 2 or phase 3, or that those phases will actually impact Obamacare is probably still sending his banking information to that guy in Nigeria.
American Conservative Union 2015 score: 46/100. Another RINO POS like Ryan. F them both.
At my age, everyone is young. My oldest daughter, would be 67 next week (died of cancer 2012), almost the age of Harleygirl.
But I am a Trump man through and through, and what he wants, I want. In all my years, he is the only one in WDC that I feel I can trust to do the right thing.
Trump is the man. Now to tax cuts and the building of the wall. So much to do......
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