The Graham-Cassidy Obamacare replacement bill has a chance of passing in the Senate. This would be a huge win for the Republican Party and President Trump. While it’s not the full repeal that many want, it’s a step in the right direction because it plugs in a federalist mentality into the distribution model, plus it defunds Planned Parenthood. Moreover, it removes the individual and employer mandates.
As much as I want to support this bill, I can’t. It misses on the two most important reasons we’ve been screaming for repeal over the last seven years.
Before we get to those, let’s discuss the positives. Paul Mirengoff over at Powerline laid out the broad strokes of what the bill accomplishes:
- Repeal Obamacare’s individual and employer mandates.
- Repeal the medical device tax.
- Enhance the states’ ability to waive Obamacare’s regulations.
- Give to the states in block grants dollars that currently are being spent by the federal government in the form of Medicaid expansion, tax credits, cost-sharing subsidies and basic health plans, with these dollars to be devoted to health care, mostly at the states’ discretion.
- Grant federal money to states in proportion to their population of poor people.
That last point is troublesome, though not worth debating before seeing the CBO report. Otherwise, these are all distinct improvements over the current state of affairs with Obamacare. The fourth point – replacing federal spending with block grants to the states – is a major improvement that falls in line with our principles of more control for the states, less for DC.
All in all, this seems like the type of bill we should get behind. Unfortunately, doing so would require us to forget the two biggest problems with Obamacare, problems that this bill completely fails to address.
Problem #1: It’s still top-down healthcare
Enhancing the states’ ability to waive Obamacare regulations is nice, but it’s backwards. The ability to “waive” is not the same thing as the ability to establish an appropriate solution specific to the needs of an individual state itself. This plan essentially tells the states, “Here’s what you must do, but you can opt out of some of it.” Instead, a true repeal would say, “Do what’s best for the people in your state.”
Don’t confuse the block grants’ step towards federalism as a sign that it’s worthy of support. It maintains the vast majority of federally mandated regulations implemented by Obamacare. As Heritage Action CEO Michael A. Needham noted in response to the bill, “Any reforms that maintain the law’s onerous federal regulations will ensure networks continue to narrow, premiums continue to rise, and choice continues to decline.”
That’s a perfect segue to the bigger of the two problems:
Problem #2: Americans will not see cheaper nor improved health coverage
The reason that small-government Republicans like Mike Lee and Ted Cruz will likely support this bill is because it’s a step in the right direction in making Obamacare more palatable, but therein lies the problem. It’s not really repealing Obamacare. It’s simply rebranding it while redistributing the federal expenditures differently. We don’t need a more palatable DC-operated healthcare system. We need a healthcare system that doesn’t answer to DC at all.
What does this bill not do? It will not reduce premiums or deductibles. In fact, by keeping the cost-driving mandates in place while eliminating the individual and employer mandates, this bill will almost certainly accelerate cost increases.
What’s the point of a repeal and replace bill that doesn’t solve the one problem Republican lawmakers have been complaining about from the start? If it’s not going to make healthcare more affordable, higher quality, or both, then it’s a worthless exercise. All of the benefits of the bill are great, but they do not address the biggest problems with Obamacare.
Let’s call this exactly what it is. Passing this bill would be a much-needed victory for a party that has demonstrated its impotence. This is a last-ditch effort to pass something, anything, so they have that notch on their belt before the midterm elections. That’s it.
It does not reduce the size of the federal government despite its pseudo-federalist stamp of approval through block grants and state waivers. Lest we forget, this is still all about DC keeping the money flowing through DC. That it then gets distributed to the states doesn’t change the fact that they’re collecting the tax dollars in the first place.
There are two arguments to be made for supporting this. The first is obvious; it’s better than Obamacare. Unfortunately, it’s only moderately better. As Rand Paul said, it’s just Obamacarelite. The second argument for supporting it is that it can hold back the single-payer wolves. The Democrats’ “Medicare for All” is picking up steam. Some believe that a clean repeal would only embolden them.
Then again, the opposite might be true. Obamacare planted the seed for socialized medicine. By maintaining the general sentiment of Obamacare, the GOP is only prolonging America’s exposure to federal management of healthcare. Every new day increases the temporal distance to a time past when the free market economy crafted the most innovative and robust healthcare system in the world. Did it have problems? Yes. Should those problems be addressed? Absolutely. Does this bill address them in a righteous manner? Not one bit.
Until we remove DC completely from the healthcare system, we’re not going to see lower premiums. We aren’t going to see better healthcare. Don’t fall for any arguments that this bill is a first step. It’s the only step. They’ll call it a day and let this continue to eat away at our economy for years until single-payer rears its ugly head. The only way to prevent Obamacarelite from becoming Berniecare is if we get DC out of healthcare altogether.