Sunday, 26 February 2017

Will Republicans Renege on ObamaCare Repeal?

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“They’ll fix Obamacare, and I shouldn’t have called it repeal and replace because that’s not what’s going to happen. They’re basically going to fix the flaws and put a more conservative box around it,” insisted former Republican House Speaker John Boehner of Ohio at a healthcare conference in Orlando.

Boehner’s comments received immediate push-back from some Republicans who are just as insistent that the troubled government health care program is going to be junked. “The last time I checked, Boehner doesn’t have a vote anymore,” reacted Senator Ted Cruz (R-Texas). “This is a test. It’s a test for Republicans in the executive and both houses of Congress. Do we honor the promises we made? This election was a referendum on repealing Obamacare. I think failure is not an option.”

Cruz concluded, “We’ve got to keep that promise, and I believe we will.”

The question is, Will the Republicans pass the “test” of keeping their much-repeated promise to repeal ObamaCare?

Boehner contends that Republicans are simply too divided on exactly what to do after the repeal of the hated law to fulfill their pledge to ditch the law. In fact, Boehner ridiculed the very idea that Republicans would do so, saying that he “started laughing” when Republicans claimed that they are going to move at lightning speed to repeal ObamaCare — and then pass an alternative.

“In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a health care proposal should look like. Not once.”

The dilemma facing the Republicans is instructive. Once a new government program is in place, it becomes extremely difficult politically to ever abolish it, no matter how bad it is. Former President Ronald Reagan lamented that a government program was the closest thing to eternal life found on this planet. While a majority of Republicans can agree that they do not want ObamaCare, they must cobble together enough votes for what to do instead of it — replace it with a new program, repair the program, or simply let it die.

“I told some of the Republican leaders when asked, I said, if you pass repeal without replace you’ll never pass replace, because they will never ever agree on what the bill should be. Perfect always becomes the enemy of the good,” Boehner argued.

Another concern among Republicans is that the Democrats will filibuster a repeal of the law. And, while Republicans could axe much of it through the budget reconciliation process, they cannot use that for all parts of the bill.

But other Republicans are not buying that objection. Speaking at the Conservative Political Action Conference this past week, Representative Mike Burgess (R-Texas), told attendees, “Yeah, it’s gonna happen. We will get it done.” The only time frame he could offer, however, was that ObamaCare would be gone before next year’s CPAC meeting in February 2018.

Burgess is the chairman of the Health Subcommittee of the House Energy and Commerce Committee, which is working on a replacement to the healthcare law. He said that those parts of the bill which cannot be nixed by the reconciliation process can be gutted via administrative changes. The repeal bill would be just the “opening act to take Obamacare out.”

The most important thing to eliminate, Burgess said, was the individual mandate.

“We must and we can repeal Obamacare now,” said former Senator Jim DeMint (R-South Carolina), who now leads the Heritage Foundation. He asked CPAC attendees to pressure their own senators and House members to just pass the same clean repeal bill to President Trump which was vetoed by former President Obama. “They should send that same bill to President Trump right now.”

DeMint rejected the argument that Republicans must have a replacement package in place before repeal, calling it “absolutely ridiculous.”

He contended that doctors, hospitals and insurance companies would not vanish just because ObamaCare was repealed. This is, however, the message put out by much of the liberal media, and the Congressional Budget Office (CBO) has stated that as many as 18 million would lose their health insurance, followed by higher premiums, if the law was repealed.

Ironically, it was the Heritage Foundation that first floated the idea of the individual mandate as a way to make sure the system was not overloaded with freeloaders who could afford health insurance, but just decided not to take it. The concern then was that millions of Americans who neglected to be insured then wound up on some public method of coverage when some had an unexpected accident or catastrophic illness.

DeMint was not the president of Heritage at that time, and the more limited mandate concept that Heritage suggested in the 1980s was dropped years ago.

The House Freedom Caucus has voted to simply pass the same repeal bill that Obama vetoed. Former Caucus Chairman Jim Jordan (R-Ohio) said, “I start from the premise that health care will be better and cost less when Obamacare is gone.”

Among the more popular replacement plans has been offered by Representative Mark Sanford (R-South Carolina), and Senator Rand Paul (R-Kentucky). Paul favors a simultaneous repeal and replacement of ObamaCare. Jordan said he would favor a free-market replacement at the same time, if it were up to him, “But if it doesn’t [happen] of course I’m going to vote to repeal it.”

The Paul-Sanford Plan would terminate the Medicaid expansion of ObamaCare, detach health insurance from employers, offer a tax credit (up to $5,000) to fund Health Savings Accounts (HSAs), eliminate the bulk of the costly regulations of ObamaCare dictating what health plans must cover, and allow insurers to sell policies across state lines. The present ObamaCare regulation, which forces even single men to purchase maternity coverage, would be ended, along with the present mandates for birth control coverage.

“We were tired of waiting” on House leadership to roll out a plan, Jordan said, explaining why the House Freedom Caucus has gotten behind the Paul-Sanford plan. “That’s why we said: Let’s go. Let’s go now.”

Senator Paul argued that HSAs would drive down the cost of healthcare. “What if 30 percent of the public had Health Savings Accounts? What do you do when you use your own money? You call up doctors and ask the price... if you create a real marketplace, you drive prices down.”

The money in the plan for HSAs could not be used fund elective abortions.

The tax credit idea in the Paul-Sanford legislation is at odds with a plan floated by Speaker of the House Paul Ryan, who wants a “refundable tax credit” to help consumers pay for various plans. To some critics, however, this is considered too similar to the subsidies offered to purchase insurance on the “exchanges” created by the Affordable Care Act.

Paul was among those critics of the Ryan proposal. He said he favored a smaller tax credit, one that “not everybody” would receive. “It’s not refundable in the sense that if you didn’t pay taxes you get money. A new refundable tax credit is a subsidy by another name.”

Some Republicans are no doubt wary of 2018 congressional elections, in which 24 Republicans must seek re-election in districts won by Hillary Clinton in the last presidential election. While there is a presumption that the supporters of ObamaCare are mostly lower-income individuals, the reality is that powerful corporate interests, such as hospital chains, favor anything they believe puts more money into their bank accounts. And these are the folks that write campaign checks.

In the end, in order to get a bill through Congress Republicans will likely have to build that will please those who favor outright repeal of ObamaCare, and those who simply want to “repair” it.

Because of the conflicting viewpoints, which divide congressional Republicans, many members of Congress are looking down Pennsylvania Avenue, hoping the White House will take leadership of the issue.

Perhaps the most powerful lesson in all of this is the best way to get rid of a government program is to not enact it in the first place.

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