By RICK MANNING
Remember the good old days when Republicans were against the nationalization of 1/6 of the nation’s economy through Obamacare. Fortunately, Representative Mark Meadows and many others in the GOP Conference do as they seek to hold Speaker Ryan to the rhetorical standard that so many in House Leadership raised for the past six years.
As Ryancare battle rages in House of Representatives, many are questioning why so many conservatives find the Speaker’s approach noxious. Fortunately, the Texas Public Policy Forum has listed ten reasons why the Speaker’s health care bill falls short, not only of repealing Obamacare, but of refocusing our nation’s health care system toward patient care and away from worrying about insurance coverage.
But on Washington, D.C.’s political scoresheet, the real story is the willingness of House Freedom Caucus Chairman Representative Mark Meadows (R-NC) to stand up and oppose what can only be described as a bad, bad bill. On Tuesday, Meadows was reportedly called out for his opposition to the bill by President Trump in a meeting of House Republicans on Capitol Hill. The President recognized that Rep. Meadows worked hard for his election in North Carolina, and (some say jokingly) warned him that he’d be coming after him on this vote.
Joking or not, the message was clear that in spite of all the hard work Representative Meadows and his wife Debbie did to elect the President in the critical Tarheel State, he was likely to face the President’s political wrath if he continued to lead opposition to the disastrous Ryan plan. A plan that the Congressional Budget Office reports will result in continuing health insurance rate increases as it fails to deal with the underlying problems with national health care.
It takes a person of unusual character and integrity to stand against a President who you just recently helped elect, but Mark Meadows understands that restoring our health care system to a free market orientation is too important to play politics over.
The people of the 11th District of North Carolina owe their Congressman a great debt of gratitude for standing firm, as Mark Meadows is exhibiting the kind of courage that Americans expect but so rarely receive from their elective representatives.
To provide perspective on what is at stake, the Texas Public Policy Forum listed as the Top Ten Conservative Concerns with the American Health Care Act, also known as Ryancare.
- Doesn’t Improve Care. Obamacare expanded the federal bureaucracy at the expense of quality care. Tax dollars were taken from providers and used to pay administrators, consultants, lobbyists, insurers, and regulators. The House bill does nothing to change that dynamic.
- Raises Insurance Premiums. The Congressional Budget Office believes that the bill will raise insurance premiums by 15-20 percent on average in the next two years, with even higher spikes in some areas. Americans care most about lowering health costs and making coverage affordable—yet the bill falls short on that count, retaining all but one of Obamacare’s costly mandated benefits and insurance regulations.
- Doesn’t Repeal Obamacare. Lost in the question of whether or not the bill’s replacement provisions represent “Obamacare Lite” is the fact that the bill as currently drafted represents “Repeal Lite”—when compared not only to full repeal, but even to the 2015 reconciliation bill that passed both houses of Congress. The bill retains all but one of Obamacare’s benefit mandates, some of its taxes, and keeps Medicaid expansion to the able-bodied in perpetuity.
- Expands Obamacare. Rather than repealing all of the law, the House Republican bill instead expands Obamacare’s subsidy regime—extending it to millions of individuals off of insurance Exchanges for 2018 and 2019—and revises the subsidy regime for 2019. Some conservatives may question the need to “fix” Obamacare, when House Republicans’ legislation should revolve around repealing Obamacare.
- Creates New Entitlement. Beginning in 2020, the bill creates an entirely new entitlement—advanceable, refundable tax credits—replacing Obamacare’s form of subsidized health insurance with another.
- Fiscal Gimmicks? Under the bill, the transition from the Obamacare subsidy regime to the new system of tax credits, and a reformed Medicaid program, will take place beginning in January 2020—a presidential election year. If Congress or the Administration delay or abandon the transition due to political blowback, the cost of the House bill will soar.
- Permanent Bailout Fund for Insurers? While failing to repeal Obamacare’s risk corridors and reinsurance bailouts, the bill also creates a new “Patient and State Stability Fund,” designed to provide most of its $100 billion in grants to subsidize health insurers. Some conservatives may question whether this grant program will end in 2026 as scheduled under the bill, or whether health insurers instead will make claims on Washington for federal bailouts to the tune of billions of dollars annually.
- Federally Controlled, Not Patient-Centered. Notwithstanding some important structural changes to Medicaid that respect states, the House bill claims to be patient-centered but still denies a 60-year old the ability to opt out of paying for maternity benefits. Supporters of the House bill talk about giving more flexibility to states, but leave all the federal insurance mandates in place.
- Perpetuates Medicaid Expansion. The House Republican bill allows states to keep their Medicaid expansion to the able-bodied in perpetuity—a major change compared to the 2015 repeal bill. CBO concluded that many states will in fact keep their expansions, diverting funds from covering the most vulnerable to expand Medicaid to able-bodied adults. Moreover, the House bill maintains Obamacare’s enhanced Medicaid match for nearly three years, encouraging expansion states to sign up more able-bodied adults between now and January 2020 to receive additional federal funding.
- Inadequate Verification. By relying on Obamacare’s system of verifying eligibility for the new tax credit entitlement, the bill requires verification of citizenship but not identity—continuing Obamacare’s problems of fraudulent applicants obtaining subsidies. In addition, some conservatives may be concerned that even these inadequate verification provisions could be stripped due to procedural concerns in the Senate.
Even at this late date, Congress can still repeal Obamacare and respect the people, the Constitution and the states by defeating this version of Ryancare on the floor, and moving ahead with legislation that at the least mirrors the 2015 repeal language that passed Congress, and replace Obamacare with a system that returns power to the states, restores health care choices to the people and allows health care markets to determine products being offered to meet the needs of consumers.
Should, as this author hopes, Ryancare fail this week, it does not signal the end of the process, but a new beginning where consensus can be created around solutions that the GOP has long espoused. This is the way legislation is supposed to work. For all the doomsayers, they need to wake up from their swampy haze, and remember their promises when they campaigned against Obamacare. A pathway to a good health care bill is available, but House Leadership needs to re-read their campaign brochures and take it.
Thank goodness for people like Mark Meadows, who is reminding them of what it means to be a free market, limited government Republican.
The author is president of Americans for Limited Government.
COMMENTS DISABLED BY SITE.
YOU MAY, HOWEVER, COMMENT THROUGH FACEBOOK.