Trump appears to be borrowing some of the language behind a traditional conservative Republican health reform proposal, which involves facilitating competition in health coverage through the sale and purchase of insurance products across states. It’s sometimes referred to as interstate competition or competitive federalism, or even just “consumer choice.” The origins of this proposal have a history of almost 15 years. Some business groups in the small-group market started floating the outlines of this idea in 2001. I wrote the first draft in policy terms at a Cato conference in July 2001, and subsequently published the academic-style version in the Cato Journal the following year. Then-Rep. Ernie Fletcher (R-KY) proposed the first legislative bill on this front in 2002. Subsequent tweaks to those concepts on Capitol Hill were championed by then-Rep. John Shadegg (R-AZ), and, in later years, by Rep. Tom Price (R-GA) and Rep. Marsha Blackburn (R-TN). Presidential candidate Ted Cruz introduced a bill similar to Blackburn’s in the U.S. Senate.
Earlier this month, Speaker Paul Ryan announced six task forces, each comprised of House Committee Chairmen, to develop a “bold, pro-growth agenda.” What was remarkable was that one of the task forces was on health care reform. Many had thought Congressional Republicans were investing too much time and energy grandstanding Obamacare repeal, and not enough developing a credible alternative.
That may have changed with the selection of four Committee Chairman to the Health Care Reform Task Force. They are: Budget Committee Chairman Tom Price (R-GA), Education & the Workforce Committee Chairman John Kline (R-MN), Energy & Commerce Committee Chairman Fred Upton (R-MI), and Ways & Means Committee Chairman Kevin Brady (R-TX).
The White House’s defeat on that, as well as several other Obamacare taxes, comes as a series of problems have piled up since coverage expansion kicked in two years ago, from collapsing co-op health plans to double-digit premium increases. No single one of them is likely to prove fatal, but together they have significantly weakened the law that Obama spent much of his presidency fighting for.
By joining with Republicans to delay the Cadillac tax, in particular, the president’s party chose the short-term demands of organized labor — a key ground-game player going into an election year — over the long-term goals of Obamacare. They offered fresh ammunition to Republicans who say the law is a money pit. And they showed a lack of political will to make Americans change their habits on health care spending.
“Is it the death knell? No. But it is harmful,” said Peter Orszag, Obama’s OMB director during the drafting of the law.
The Affordable Care Act also grants substantial flexibility in its implementation, a feature Mr. Obama has repeatedly exploited. The new president could suspend penalties for individuals and employers, enforce income-verification requirements, ease the premium shock on young enrollees by adjusting the community rating system, allow different pricing structures inside the exchanges and alter provider compensation. These actions could begin dismantling the most pernicious parts of ObamaCare and prevent its roots from deepening as Congress debates its repeal and replacement.
So let’s recap. Obamacare has depressed job growth, costs are escalating at a higher rate, barely a dent has been made in the numbers of uninsured, and insurers are either exiting the markets or failing altogether. Under any other circumstances, a program that failed on its promises so badly would have all sides moving quickly to repeal it and work on a replacement. Don’t bet on that outcome from this White House and its dwindling number of Democratic supporters on Capitol Hill. They will surely try to sell us the illusion of competence and success.
That doesn’t mean we have to buy it.
Wednesday, December 9, 2015 | 8:45 – 11:15 AM
Breakfast will be served.
AEI, Twelfth Floor | 1150 Seventeenth Street, NW | Washington, DC 20036
American health care policy debates have long been divided between those who support greater governmental regulation and those who favor more reliance on market incentives and consumer choice. Passage of the Affordable Care Act (ACA) in 2010 did not end the debate, but it did increase pressure on those who are unsatisfied with the steady march toward more federal control. What is the alternative?Ten health policy experts have come together to provide an answer to that question. Their plan, “Improving Health and Health Care: An Agenda for Reform,” will be released and summarized at this public event, with commentary from some of the plan’s coauthors and respected national experts.
PARTICIPANTS Joseph Antos, AEI; James C. Capretta, AEI; Lanhee Chen, Stanford University; Scott Gottlieb, AEI; Chris Jennings, Jennings Policy Strategies; Thomas P. Miller, AEI; Tom Price, Chairman of the House Budget Committee; Robert Reischauer, Urban Institute; Gail Wilensky, Project HOPE.
Unlike Social Security or Medicare, which produced few if any losers and a vast population of winners, the ranks of ObamaCare losers are growing with every price increase and mandate imposed. Which means that no matter who is elected in 2016, Americans are likely to want the next Congress to overhaul this mess rather than merely preserve a law that is doing at least as much harm as good.