One of the signature items promised to voters by President Trump has always been the rapid repeal and replacement of the Patient Protection and Affordable Care Act (PPACA), otherwise known as Obamacare. Skyrocketing premium costs and failing insurance exchanges have made Obamacare an incredible disaster, and Republican voters have been clamoring for something better almost from the moment it was passed.
Unfortunately for Obamacare opponents, the wait may be just a little bit longer, as so far, Congress has not come up with a replacement that will be much of an improvement.
While various working groups in both houses of Congress have attempted to tackle Obamacare from different angles, the major proposed replacement of it currently being pushed by Republican Speaker of the House Paul Ryan has been criticized for retaining numerous key elements of the PPACA. This has led to a number of conservative lawmakers in both houses referring to the bill — its official name is “The American Health Care Act” — as “Obamacare 2.0” or “Obamacare Lite.”
Members of the conservative House Freedom Caucus, led by Republican Representative Mark Meadows of North Carolina, have been particularly upset that Ryan has pushed this unsatisfactory bill on the White House and has persuaded President Trump to get behind it, at least for the time being.
While Ryan has claimed that he’ll be able to round up the 218 votes in the House needed to pass the bill, this looks to be far from the case according to informal surveys of Republican representatives (Democrats are nearly united in opposition to any replacement for the PPACA). According to some judgments, as many as 70+ Republican members of the House are against Ryan’s replacement bill.
Conservative groups such as the Club for Growth, the Heritage Foundation and the CATO Institute have all come out against it. In the meantime, Republican Senator and former presidential candidate Rand Paul of Kentucky has formulated his own replacement bill for Obamacare and is arguing that the repeal and replacement of the PPACA should be two separate legislative acts instead of one. As Paul says:
“I think the reason why the House leadership bill is Obamacare Lite is because it retains subsidies. Obamacare had subsidies for people to buy insurance. In the Paul Ryan bill, they keep the subsidies — they just call them refundable tax credits.
Some people are predicting that it’s actually going to be more expensive than the subsidies we have under Obamacare. This isn’t you getting your own money back; this is you getting somebody else’s money.
So, a family that makes $30,000 a year could actually get $14,000 that they didn’t pay. Let’s say they paid zero in income tax; they could get $14,000 back. One, we don’t have the money — it’s a new entitlement program, and two, if you get $14,000 back, do you think the insurance company is ever going to sell insurance for less than $14,000? That becomes the floor. So, it actually pushes insurance rates up — it doesn’t allow insurance rates to fall. So, that doesn’t allow insurance rates to fall, and it sets up a new entitlement.
The second thing that Paul Ryan’s Obamacare Lite bill does is they keep the Obamacare taxes — all of them — for a year. And then after a year, they keep the Cadillac Tax forever. That’s the tax on if you have really good insurance, Obamacare taxes that. So will Paul Ryan’s plan.
The third thing they do that is Obamacare-like is they keep the individual mandate. It seems like every Republican says they were against the individual mandate. That’s if you didn’t buy insurance, you had to pay a penalty to the government, a tax. Obamacare Lite — Paul Ryan’s plan — just changes it so you have to pay a penalty to the insurance companies. I consider that to still be a mandate that isn’t consistent with those of us who want less government involvement.
So they keep the subsidies, they keep the taxes, and then they keep the mandate. Then the fourth thing they do is they actually subsidize the insurance companies. Right now, insurance companies are losing money, and Obamacare has this rescue thing called ‘risk corridors’ to bail out the insurance companies. Paul Ryan has got the same thing; he just calls it reinsurance, and it’s $100 million worth. I predict that might not even be enough.
So, I don’t like any of it. Now, I do think we agree as Republicans on repeal. But I don’t think we agree on the replacement. That’s why I say we should separate them — vote on repeal, and then, vote the same day on a separate bill that’s called replace.”
Another problem with Ryan’s “Obamacare Lite” bill is that it could allow illegal immigrants to obtain Medicaid funds. “I think that is a concern — a valid concern,” said Paul. Most conservatives are in agreement with Paul on this issue.
President Trump is going to be flying down to Kentucky to meet with Senator Paul about Obamacare replacement, but in the meantime, several analysts are questioning why Speaker Ryan has been pushing an unsatisfactory replacement for the PPACA, which has already been declared “dead on arrival” in the Senate.
There are two main theories being floated: one is that Speaker Ryan is incompetent and simply didn’t do his homework with this bill (most of which was formulated outside the normal committee process in working groups that weren’t open to the public or other members of Congress).
The other theory is that Ryan doesn’t want any replacement for the PPACA at all. This is because, for some people, Obamacare actually is very popular. A replacement that delivers less health care (by the estimate of Republican Senator Susan Collins of Maine, between six and 10 million people could lose their healthcare coverage under Obamacare Lite) or decreases premium credits (Collins said in her state that some seniors could be affected this way) might sound good in the abstract, but to voters in the real world, the sudden elimination or reduction of what seems like a government entitlement can be a slap in the face — one that could have ramifications at the ballot box in 2018 and 2020.
While it’s true that Republicans currently enjoy dominance in both houses of Congress, the presidency and in state legislatures, the lesson of midterm elections is that usually the dominant party is the one that loses seats, and even if Republicans can manage to hold on to their majorities, there’s only so much voter anger that they will be able to weather.
Therefore, Ryan’s pushing “poison pill” legislation may be the best way for him to salvage popular support for the Republican majority currently in the House.
It remains to be seen how the battle over Obamacare will play out. But for now, it appears that Rand Paul’s solution of a repeal that’s separate from Obamacare replacement would seem to be a good idea (in theory, repeal would be agreed to, but delayed until a final replacement bill can be settled upon, and then both acts would be passed the same day).
In the meantime, let’s hope that Congress can keep this agenda item alive and moving forward without having to make substantial compromises — or big cuts in the coverage that’s currently provided.
~ Conservative Zone
