Some cities and states are trying to fix the Affordable Care Act’s deficiencies all on their own. New York City, for example, has pledged to directly pay the medical bills of the city’s estimated 600,000 uninsured.
Massachusetts is looking at some form of “Medicare-for-All,” at least in name, because that name polls very well (when details and costs are left out).
And, despite the $400 billion price tag, California Gov. Gavin Newsome is pushing a single-payer system that would combine all federal funds (including veterans’ health benefits) into a solitary system that the state would control.
I say great! More power to them — and I mean that quite literally. More power to the states.
That might seem an odd position for me to take: I’m lead counsel for the individual plaintiffs in the case where U.S. District Judge Reed O’Connor ruled last month that the Affordable Care Act (more commonly known as Obamacare) is unconstitutional.
Through the Texas Public Policy Foundation’s litigation Center for the American Future, I represented our individual clients, who have been harmed by the ACA in the ways that so many other Americans have been harmed. They didn’t get to keep their doctors; they didn’t get to keep their insurance plans; they never saw the “$2,500 savings” we were all promised. Their insurance premiums shot up and their choices plummeted. They lost their preferred doctors. Looming over all of it is a deductible so high that they’re making unenviable decisions — do they take their boys to the doctor for a sniffle, or see if they can ride it out?
The decision in our case will certainly spend years in the appeals process, but that doesn’t mean that real reform has to wait.
The ACA is broken — it has been from the start. That’s something we at the Texas Public Policy Foundation, the Republican attorneys general who brought the lawsuit in the first place, and even the Democratic leaders in New York City, Massachusetts and California can agree upon.
If the ACA was working as planned, why does New York City have 600,000 uninsured? And California have 3 million uninsured? All three of the jurisdictions I have cited opted into the ACA to expand Medicaid (something Texas didn’t do), so the only explanation is that people have failed to buy insurance because it doesn’t meet their needs — good coverage at an affordable price.
TPPF, Republican attorneys general, and those Democratic leaders now agree on something else: The federal government isn’t the way to regulate health care.
With a divided federal government, there’s no real chance for health care reform in the foreseeable future. But things don’t have to go through the federal government. States can and should step up.
It’s called federalism, where under the Tenth Amendment to the United States Constitution, “the powers not delegated to the United States by the Constitution … are reserved to the states respectively or to the people.” It’s a founding principle of our nation of keeping the right balance between federal power and state power.
States aren’t all the same. Something that works in Massachusetts may not work in Texas. Californians may have different ideas and different priorities than Louisianans. As Congressman Chip Roy (R-Texas) said, “let California be California — let Texas be Texas.”
U.S. Supreme Court Justice Louis Brandeis famously called states “the laboratories of democracy,” which can “try novel social and economic experiments without risk to the rest of the country.”
I don’t agree with what New York City Mayor Bill de Blasio wants to try in his city, but unless he shows up in Washington a few years down the road for a federal bailout, I know his policies will have little effect on me. Likewise, we in Texas should be able to bring market forces back into the health care industry, as Gov. Greg Abbott has proposed, and de Blasio should be able to rest assured that he won’t have to deal with it.
True, health care will operate differently in different states, but that is how every issue works that is properly left to the states to address. This is the path forward — returning health care and health policy to the states, where it belongs. And, by doing so, states will begin to advance 50 imperfect solutions that will slowly lead us back to health care freedom in the United States, where people can regain their choice of doctor, keep the coverage they want, and be able to afford quality care.
Robert Henneke is general counsel and litigation director at the Texas Public Policy Foundation and lead counsel for the Individual Plaintiffs in the pending Texas v. U.S. lawsuit. Follow him on Twitter @robhenneke.