This commentary was originally featured in the Washington Examiner on January 19, 2018.
In an interview with NPR late last year, Senate Majority Leader Mitch McConnell announced the Senate would turn away from pursuing Obamacare repeal through budget reconciliation in 2018 and “probably move on to other issues.”
Indeed, as the second session of the 115th Congress gets underway, there have been many statements from both the Trump administration and congressional leadership about bipartisan approaches on spending, infrastructure, and agriculture policy.
These may be goals that are easier to achieve, but turning away from Obamacare repeal is both bad policy and political folly.
To paraphrase Boromir from "Lord of the Rings," one does not simply walk away from Obamacare repeal.
Despite Congress’ repeated failure last year to repeal the law, members were able to achieve a smaller policy victory by repealing the individual mandate through the Tax Cuts and Jobs Act. As a constitutional matter, this was a solid win for the rule of law and a sharp rebuke to the Supreme Court’s 2012 decision to define the mandate as a tax.
But as a practical health policy matter, the repeal of the individual mandate will have minimal impact in driving down premiums and deductibles. Indeed, premiums are very likely to continue their skyrocketing increases this year as younger, healthier people opt out of Obamacare’s exchanges and the sick and indigent make up larger proportions of the exchange population.
While some believe this could accelerate the law’s collapse, the very real short-term impact is an acceleration in the cost of healthcare unless Congress fully repeals the law.
The reason for these continued premium increases is that Obamacare’s federal health insurance mandates — guaranteed issue, community rating, essential health benefits, the under-26 mandate — all remain a part of the law. These onerous federal requirements on insurers are responsible for patients’ and families’ exorbitant costs, diminished care quality, narrowed provider networks, and the degradation of the overall system.
The only way to lower healthcare costs is to repeal these insurance mandates and return control of health insurance markets back to the states. This at least provides the opportunity for real markets to emerge outside the federal centralization that has wrecked millions of people’s lives. These markets could help drive down costs and force insurers to compete for our business with products tailored to our specific health needs.
And it gives states like Texas the ability to innovate to deliver better care at lower costs to the relatively small population in the individual market with pre-existing conditions.
Access and affordability remain the biggest issue for many households.
Millions of people have seen tripled premiums, canceled plans, and drastically diminished provider options since Obamacare was implemented in 2013. Indeed, some are paying more for their monthly healthcare premiums than for their home mortgage.
This is a situation that cannot persist. And it’s something that will quickly wipe out whatever positive impact that the recently passed tax cuts will have in providing financial relief to the working class.
It is folly for Congress to just walk away from the number one domestic policy issue after eight years of promises for full repeal. And Congress will only make matters worse if it attempts to reach back into people’s wallets to again bail out insurance companies.
It will undoubtedly be difficult to repeal Obamacare in 2018. And indeed, the reconciliation process may very well be used for something else positive, like welfare reform. But that does not change the fact that the misery of Obamacare will continue to be felt.
It certainly does not change the fact that Congress and this administration will be held liable for failing to carry out their promises.
Congress may very well choose to move on to something else. Millions of Americans affected by Obamacare’s failure don’t have that luxury.