Reports of Republicans giving up on repealing and replacing Obamacare are greatly exaggerated, according to Galen Institute President Grace-Marie Turner, who is not only confident the GOP will address the issue again this year but is part of the team trying to make it happen.
Republicans have achieved a few wins on the health care front over the past year, namely the repeal of the individual mandate in the tax legislation, the repeal of the Independent Payment Advisory Board in a spending bill, and the end of cost-sharing reduction payments to insurance companies through executive action from President Trump.
When Republicans tried but failed to restore funding for the cost-sharing reduction payments in exchange for removing burdensome regulations from the individual health insurance market in the recent omnibus bill, many feared the GOP was giving up on addressing health care in a meaningful way this year.
Turner says that’s not the case. First of all, she says the failure of Republicans to restore the subsidies to insurers was a major blessing.
“The measures that they were considering as part of the omnibus spending bill were really just papering over the problems. And with Obamacare, they were ready to throw tens of billions more dollars into this black hole of Obamacare. It was not going to fix anything,” said Turner.
But Turner also insists Republicans are ramping up for another legislative push to dismantle Obamacare this year.
“Congress is going to have to come back to a full repeal and replace measure and we have been working every week since October to refine this legislation at the behest of the Senate. (Former) Sen. Rick Santorum has really been the energy behind this effort,” said Turner, who also explained the other players in the effort.
“Heritage Foundation, Ethics and Public Policy Center, the American Enterprise Institute, a lot of state-based think tanks and a lot of experts from around the country have been putting together a proposal that we believe cannot only get majority support in the Congress but majority support of the American people to fix this for good,” said Turner.
In 2017, the House of Representatives passed reform legislation but the Senate failed on several different bills. Republican Sens. Susan Collins, Lisa Murkowski, and John McCain voted down all GOP bills. Since then, Republicans lost a Senate seat in Alabama and McCain has been home battling cancer. On most days, the GOP holds a 50-49 voting majority.
Turner says the focal point of this effort will look less like the bills that tanked last summer and more like the Graham-Cassidy bill that failed to advance in September. the sponsors were Sen. Lindsey Graham, R-S.C., and Sen. Bill Cassidy, R-Louisiana. Cassidy is a longtime physician.
“That bill was based upon a different approach, a federalist approach to return money and power to the states to ultimately empower individuals to have more choice and more control over their health insurance,” said Turner.
“We’ve got to devolve power to the states and they need resources in addition to new flexibility to be able to provide people with the kind of policies they actually want to buy instead of what they’re forced to purchase. They would use the money to make sure that they purchase private coverage and that they have many more choices and that the coverage is more affordable,” said Turner.
She says Obamacare is a proven disaster and is only getting worse because more people are getting out of the system and leaving older and sicker people to deal with soaring premiums.
“Obamacare is becoming one big high risk pool. That means millions, probably tens of millions of people, are being shut out of health insurance. They need a different place to go. That’s what states can do. States can figure out how they can revive their individual and small group health insurance markets,” said Turner.
But Republicans have a problem besides finding a majority to support any legislation. The budget reconciliation rules that allowed them to attempt passage with a simple majority expired in September. Right now, they would need 60 votes to get anything done.
Turner is confident the Senate GOP leaders could ramp up support for another budget reconciliation rule, and she believes this time they would do it right. Turner says a big problem with the process last summer is how the rules were structured.
“They did it backwards last time. This time we’re going to do it the right way, starting with good policy and then create a vehicle to get that enacted,” she said.
So what happened last time?
“What they did is pass budget reconciliation instructions to create the pathway for the repeal and replace legislation they wanted to pass. And they had to fit it in to that channel and it didn’t really fit,” said Turner.
“As one of my colleagues said, they just kept having to pull limbs off of it until it would fit through that process. At the end, nobody really liked the product. We’re doing this differently. We’re starting out by creating a product that we believe can work and that people will like and then they’ll write the budget reconciliation instructions around that,” said Turner.
Turner says the polls consistently show health care is the number one concern of voters and the GOP must make another push this summer.
“How can they go back to their voters and say, ‘Oh, sorry. We know we told you for four election cycles we were going to repeal and replace Obamacare but it was just too hard.’ They can’t do that,” said Turner.