Listen to “Why Didn’t Republicans Get Health Care Reform Done?” on Spreaker.
In the second part of our interview with American Commitment President Phil Kerpen, we examine why Republicans failed to coalesce around a health care reform bill despite controlling the House, Senate, and White House and having seven years to prepare.
Kerpen explains how close Republicans came on multiple occasions and why they landed on the best approach when it was too late.
Grassroots activists and state officials are making another push to “repeal and replace” Obamacare, and a leading figure in the effort believes there is a 50-50 chance it can get passed before the midterm elections.
“Health reform is not dead,” said Galen Institute President Grace-Marie Turner, who has been working with other activists to revive the effort ever since the Senate failed to advance legislation last summer. They plan to hold a press conference outlining their reform principles this coming week.
“Next Wednesday afternoon, here in Washington, with a number of governors, state legislators and others,” she said.
Turner says this new approach builds upon a last-minute effort by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., that would move much of the authority to make health care policy out of Washington.
“It’s based upon the chassis of Graham-Cassidy with block grants to the states but with a lot of refinements that make this a much better bill,” said Turner. “We need to move resources and authority back to the states to heal their health insurance markets that have been broken by Obamacare.”
What would her preferred legislation actually look like?
“Basically we’re saying this money that’s currently going to insurance companies, dumping more and more money into Medicaid, these sort of open-ended entitlements. Let us turn those into a block grant and distribute that money among the different states and give them more flexibility in how they spend that money in order to provide better choices for health insurance and lower costs,” said Turner.
Turner says there would still be federal subsidies associated with the plan to help people afford private, commercially available health insurance. There would also be funds for patients facing chronic illness or major events like organ transplants.
She adds that the individual market was badly hurt by Obamacare, despite endless promises to the contrary.
“We actually have no more people covered in the individual market today than we did before Obamacare passed. We spent all this money. We have turned our health care system upside down and no [additional[ people have private health insurance.
“Yes, there are more people covered (overall), but the great majority of them are on Medicaid which, as we know, is a terrible program for people,” said Turner, noting Medicaid patients have a terrible time finding primary physicians who will see them and certain specialists are also almost impossible to get.”
She says legislation grounded in the ideas she is pushing would open many more doors for patients.
“People need the option of private coverage, quality coverage, that gives them not only access to coverage, but actually access to care,” said Turner.
But will activism among the grassroots and the state level get Congress to take up this issue so close to Election Day?
“We believe the Senate is going to take our recommendations seriously and hopefully we’ll be able to move this forward. We think there are a lot of forces that are going to bring them back to health reform this summer, even though they’d really like to do something else,” said Turner.
Turner is also buoyed by the news that the Senate will remain in session for most of August and is confident Senate Majority Leader Mitch McConnell will bring the issue to the floor if he knows there are 50 votes to pass it. Republicans would once again need to approve the reconciliation process for the debate since there is no chance of getting 60 votes for the legislation.
We think it won’t be very hard to get it through the House. The Senate is really where the focus will be over the next several weeks,” said Turner.
“I’m pretty optimistic. I’d give it a 50-50 chance, which is a lot more than most people on Capitol Hill would give it,” she said.
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.
President Trump scrapped the commission he created to investigate problems with alleged voter fraud on Wednesday, blaming state leaders for refusing to share data that could help to determine the extent of any problem.
However, Trump is now asking the Department of Homeland Security to pick up the investigation and urging Congress to pass a national Voter ID law.
“Despite substantial evidence of voter fraud, many states have refused to provide the Presidential Advisory Commission on Election Integrity with basic information relevant to its inquiry,” said White House Press Secretary Sarah Huckabee Sanders in a statement Wednesday.
“Rather than engage in endless legal battles at taxpayer expense, today President Donald J. Trump signed an executive order to dissolve the Commission, and he has asked the Department of Homeland Security to review its initial findings and determine next courses of action,” she added.
Hans von Spakovsky manages the Election Law Reform Initiative at the Heritage Foundation and served on the commission until its termination.
“I’m disappointed but I understand why President Trump did this. The commission has basically been unable to do its work for more than two months,” said von Spakovsky.
He says the inability of the commission to make progress is a result both of state officials refusing to cooperate and lawsuit-happy activists grinding the work of the panel to a halt.
“We have all these state election officials refusing to provide us with the data we need with state voter registration lists so we can do the research we need to do. Also, liberal progressive groups have filed about a dozen lawsuits to stop the commission from being able to operate. The staff of the commission is spending all their time in this frivolous litigation,” said von Spakovsky.
One of the most common arguments made by state officials in refusing to turn over voter registration lists is that the federal government has no business barging in and demanding states provide the information.
Von Spakovsky says that argument rings hollow given what states constantly do with the same information.
“The information we asked for is information that all of these states routinely sell to candidates and political parties. So why they think they shouldn’t give it to this commission looking at election integrity, I don’t really understand,” said von Spakovsky, who contends the federal government has every right to see the same records.
“The federal government is entitled to that information because those voter registration lists are what are used for federal elections, elections for Congress and the president. Obviously, the federal government has a right to that information,” said von Spakovsky.
Despite the dearth of records to study, von Spakovsky says the commission’s work shows there is clearly a problem.
“Some folks who got the voter registration lists – the same information we wanted – from 21 states that represent just 17 percent of the voters in the country, and yet they found more than 8,500 people who illegally voted in more than one state in [the 2016] election,” said von Spakovsky.
On Thursday, election officials in Virginia determined the outcome of a race for the House of Delegates that would also determine the majority in that chamber. The race was deadlocked after recounts and court challenges, and Republican David Yancey’s name was drawn out of a bowl, giving the GOP a 51-49 majority.
Von Spakovsky says that race may well have been impacted by illegal voting.
“That’s a legislative district in which a group that I’m associated with discovered that in just one town, Newport News, in the last few years they’ve removed a couple hundred non-citizens who had registered in that city and had voted almost 300 times in prior elections. So it’s very possible that particular race may have been decided by people who shouldn’t have been voting,” said von Spakovsky.
So what happens now? As Trump indicated, the issue will now be referred to the Department of Homeland Security. However, von Spakovsky says DHS is going to need a lot of help.
“They can’t look into this problem without the help and cooperation of the U.S. Justice Department. That’s going to take Jeff Sessions helping them too. It looks like it’s going to have to be private groups and others like myself still trying to look into this problem,” said von Spakovsky.
Trump has one other suggestion.
“As Americans, you need identification, sometimes in a very strong and accurate form, for almost everything you do…..except when it comes to the most important thing, VOTING for the people that run your country. Push hard for Voter Identification!” he tweeted Thursday morning.
Voter identification has been pushed in many states governed by Republicans, but the more liberal states want nothing to do with it. It’s unclear whether Trump is advocating for a national voter identification law, but von Spakovsky believes it would be constitutional.
“I agree with the president. Congress could impose an ID requirement for federal elections. If they did that, that would virtually guarantee ID for all elections because in most states the state and federal elections are held at the same time,” said von Spakovsky.
However, he does not believe there is nearly enough political will to get the idea through Congress.
“Politically, don’t think it’s possible because you would have huge fights between both Democrats and Republicans over this issue. There are some states that are moving forward with this. Iowa just put in an ID requirement, but there are other states that are adamantly opposed to it like New York and California, which are two of the largest states in the country,” said von Spakovsky.
One of the newest members of the Presidential Commission on Election Integrity says he is impressed that the bipartisan group appears to be on the same page of protecting the rights of eligible voters while putting provisions in place for those who shouldn’t be casting ballots.
He also categorically rejects assertions from the political left that the commission’s actual intent is to disenfranchise vulnerable segments of the population who are unlikely to support President Trump, such as minorities, immigrants and the poor.
On Wednesday, the commission held its first meeting, a public session at the Eisenhower Executive Office Building adjacent to the White House. Vice President Mike Pence is chairman of the commission, while Kansas Secretary of State Kris Kobach serves as co-chairman.
Hans von Spakovsky is among the most recently appointed members and is excited that the group seems clear on its task.
“This is a bipartisan commission but I was really struck by the unanimity of all of the commissioners on all of the issues we need to look at, the kind of data we need to gather, and the work that needs to be done,” said von Spakovsky, who also serves as the manager of the Election Law Reform Initiative at the Heritage Foundation.
He says the goal of the commission is clear.
“This commission is going into this with an open mind, no preset conclusion, and we were directed to do everything we can to take a look at, review, and examine the American election process and make sure, in essence, that every American who’s eligible can vote and no one’s vote is stolen through voter fraud or administrative mistakes,” said von Spakovsky.
President Trump has ordered the commission to report on its findings and offer recommendations by next year. Von Spakovsky says gathering data is the first big step and getting voter information from the states is the key to understanding whether people who shouldn’t be voting are gaining access to ballots anyway.
“That’s obviously important data when it comes to looking at the kind of problems that may be out there,” said von Spakovsky.
However, the request for data is sparking significant controversy, with many Democratic state officials refusing to comply with at least parts of the request. Critics of the president’s decision to create the commission allege that the commission will end up sparking action to disenfranchise poor and minority voters, who are unlikely to back the president or have the means to protect their rights.
Von Spakovsky says that assertion is ridiculous.
“That’s really an absurd claim,” he said. “It’s really just a nutty claim, frankly. Look, this is an advisory commission. It has no power of any kind. It has no ability to tell anyone what to do. It’s only purpose is to research the issues. And all it can do at the end is to make recommendations to the president, to the states,” said von Spakovsky.
When the formal recommendations come next year, von Spakovsky says there could well be calls for Congress or the Justice Department to take action, but he says any meaningful clean-up of the voter rolls will have to happen state by state.
While the data continue to come in, von Spakovsky’s own research shows three major areas of concern when it comes to election integrity: non-citizens voting, citizens voting in multiple jurisdictions, and the names of dead people remaining on the rolls and being vulnerable to abuse.
Von Spakovsky says getting everything right is a major task.
“It is a big job. About five years ago, the Pew Center did a study and they found almost three million people registered in more than one state and almost two million people who were dead still on the voter rolls,” said von Spakovsky.
After concluding Washington is incapable of solving some of America’s biggest problems over his 16 years in Congress, former Sen. Tom Coburn, R-Okla., says a constitutionally provided convention of the states is the only realistic remedy to what ails us.
Article V of the Constitution allows for amendments through a convention of two-thirds of the states proposing changes that would then need to be ratified by three-quarters of the states. Currently, 34 states would need to get on board to force Congress to call a convention and 38 states would need to approve any proposed amendments.
“Before our constitutional convention, everything was decided through a convention like this,” said Coburn, who points out George Mason insisted on the inclusion of the convention of the states option after pointing out no government in history has ever given back power to the people.
Coburn further explained the process.
“You have to an application that aggregates (among the states). You have to have the same application everywhere. You can’t have one application for a balanced budget and one application for something else. You have to have 34 that say the same thing,” said Coburn.
The current push for a convention of the states calls for three amendments: one to balance the budget, one to rein in the reach of the federal government , and one to limit the length of terms in the House and Senate.
Coburn says a balanced budget amendment is desperately needed.
“We think the federal government ought to be fiscally responsible. They ought to have to live under the same accounting guidelines everybody else does and they ought to have to live within their means,” said Coburn. “That’s a balanced budget amendment but it also means you can’t just go and add mandates to the states to balance the budget. You have to make hard choices.”
Congress came within one vote of approving a balanced budget amendment in 1995, just months after Republicans won control of both chambers. The plan passed the House 300-132, but the 65-35 tally in the Senate was just shy of sending the amendment to the states.
The vote was really 66-34, but when it was clear the measure would fail then-Senate Majority Leader Bob Dole, changed his vote to no so he would be eligible under Senate rules to reconsider the issue. A subsequent vote also failed.
Since 1995, no balanced budget proposal has come anywhere close to passing, and Coburn says that should come as no surprise.
“They don’t want to balance the budget, because then they have to make hard choices, then they have to be accountable to their electorate. If the electorate doesn’t like the choices that they made, they’ll replace them. It’s an insurance policy if I don’t have to have a balanced budget,” said Coburn.
“The easiest thing in the world is to spend somebody else’s money and that’s what they do every day. They spend our grandchildren’s money because we’re certainly not spending our own right now,” said Coburn.
Next on the amendment list is to “limit the scope and jurisdiction of the federal government.” Coburn says a ridiculous case from 1942 effectively gave the federal government to meddle far too intimately in our lives.
“An Ohio wheat farmer grew 18 acres more wheat than he was allotted, but he used every bit of it to feed his own cattle, his own family and used it for feed the next year. The federal government said that’s interstate commerce because you didn’t buy that 18 acres worth of wheat from somewhere else,” said Coburn.
“So they expanded the commerce clause and that is what has allowed the federal government to tell every state – in everything they do now – what to do,” said Coburn.
Coburn says returning power to state and local authorities also heightens accountability, pointing out it is much easier to get an appointment with your state representative than a member of the House or Senate.
Coburn cited a recent poll showing 86 percent of Americans don’t trust the federal government. He says that places America in a crisis that returning power to states and locales can help to address.
“When you quit trusting the central authority, then you will no longer follow its will. That’s called anarchy. So we have to take back our freedom. We have to re-establish the rule of law and make sure it’s followed. But also it has to have the integrity of the central government in terms of a limited federal government,” said Coburn.
The third and final amendment Coburn and his allies are pushing would limit lawmakers to 12 years in the U.S. House of Representatives and 12 years in the U.S. Senate.
“Prior to a Supreme Court ruling in 1994, 26 states had limited the terms of their members of Congress. In an Arkansas case, the Supreme Court decided that we as citizens can’t decide whether we want to limit the terms of our federal representatives. Well that’s ludicrous. So what you do is pass an amendment that puts a limit on the amount of time people can serve,” said Coburn.
Coburn says 12 states are already on board. He expects another 10-12 states to join the effort in the next 12 months and another 10-12 in the year after that, meaning a convention of states could take place within two to three years.
He is quick to stress that the convention itself cannot ratify the amendments. That role still belongs to the states. Coburn is bullish on that front as well, noting that Republicans are just 24 seats away from controlling the legislatures in 38 states.
Ultimately, Coburn believes the success or failure of this campaign will depend upon the courage to do what has to be done.
“Do we have the moral structure with which to make these hard decisions for the future or do we just let this train run out of control down the mountain? That’s the real question,” said Coburn.
“If you love your kids, you love your country, and you love your future, you ought to be about choking down the federal government and having it live within its means, lessening it’s impact on the economy so the economy can actually grow,” said Coburn.
Dr. Tom Coburn spent 16 years in Congress and quit because lawmakers refused to make tough choices to spare future generations the burden of crushing debt, and he is now calling for a Convention of the States so state and local leaders can do the work Washington politicians refuse to address.
Coburn served Oklahoma in the House of Representatives from 1995-2001. He was elected twice to the U.S. Senate before resigning in 2015. He is also the author of ” Smashing the DC Monopoly: Using Article V to Restore Freedom and Stop Runaway Government.”
Article V of the U.S. Constitution provides two ways for amendments to be enacted. The more common way is for both chambers of Congress to approve an amendment by two-thirds majorities, followed by three-quarters of the states ratifying the proposal. However, Article V also allows for two-thirds of states to convene and approve amendments which would still require approval by three-quarters of the states.
Coburn says business as usual in Washington proves politicians are not up to the task of reining in government.
“Everybody said things would change in 2010. Then they said things would change in 2014. Then they said things would change in 2016,” said Coburn, who contends there’s a very simple explanation for why those campaign promises are not kept.
“Most members of Congress are conflicted and the conflict is this: Do I do what’s best for the country and maybe lose my election or do I do what’s best for my political career so I can maintain my status as an elite?” said Coburn. “The desire for power, which our founders very well knew, trumps everything else.”
Among Coburn’s biggest frustrations is how public service has become a career for so many, rather than lawmakers serving for a brief time and then returning to their private lives.
“If you didn’t have career politicians, they wouldn’t be looking for the next office. It’s not the public service is in any way dishonorable. It’s that motives for most of those that run today is to get and hold and advance power,” said Coburn.
As a result he says people who want to make tough choices to tackle problems like debt and spending are scorned for putting their colleagues in a difficult position.
“Their peers say, ‘Don’t do that. We’ll have to make all these hard choices. We’ll get beat up here.’ What they need is an excuse to do the right thing” said Coburn.
“They need an excuse to be able to come home and say, ‘I’m sorry I had to cut this program because we have to balance the budget. It’s dishonorable to borrow against your children. We’re going to make these hard choices and if you don’t want to re-elect me it’s fine. I’ll be happy to go back to my real job,'” said Coburn.
“But the problem is two-thirds of the people in Washington have never had a real job,” said Coburn.
Coburn says the 1995 federal government shutdown is a perfect example of lawmakers refusing to stick to their principles and allowing government to spiral out of control. The Republicans eventually buckled in the face of intense media and political pressure, and GOP leaders have been very reluctant to even threaten such a move ever since.
Coburn was a House freshman at the time and says Republicans snatched defeat from the jaws of victory.
“What we saw post-collapse of the Republican leadership was that the president was getting ready to cede the spending cuts that we wanted to make. Had we had those spending cuts, you wouldn’t be running half-trillion and trillion dollar deficits,” said Coburn.
“Leadership can either go on the basis of courage or on the basis of fear, and what you’re seeing in Washington from the career politicians is fear.” he said.
“If you’re going to shut the government down, don’t open it up until you’ve won everything you need to win. Take the heat and lose your slot. Is it better for a politician to lose an election and the country to be better off or is it better for the politician to maintain power and the kids that come after us suffer dearly,” said Coburn.
Coburn was re-elected to the U.S. Senate in 2010, but walked away in January 2015 with two years remaining in his term. Was it because Congress was doing nothing to honor its promises to get the nation’s fiscal house in order?
“It was 100 percent (that),” said Coburn. “I had told the majority leader two years before I left that I was going to leave if things didn’t change, if we didn’t start addressing the real issues, if his leadership wasn’t going to address the real issues. If he didn’t put people in position to address the real issues, there’s no reason to stay there and participate and get an ‘Atta boy’ because you’re a senator but you’re not actually accomplishing anything for the future of our country,” said Coburn.
“Nothing happened so I went to him and said, “I told you I was leaving. I’m leaving.’ I did and it was a good decision because now I’m working on the solution big enough to solve the problem,and that’s the Article V amendments convention,” said Coburn.
He says this is America’s best chance to get the ship headed in the right direction.
“The real question for you and the average American family, whether you’re liberal or conservative, is who gets to decide. Is it an un-elected bureaucrat in Washington or is it you as a free citizen in this country,” said Coburn.
Just days after winning conservative support for an amended bill to gut the taxes and mandates associated with Obamacare, Republicans are still struggling to find the votes for passage, but the man leading the legislative effort is confident the votes will eventually be there.
GOP leaders have given their blessing to an amendment championed by Rep. Tom MacArthur, R-N.J., and House Freedom Caucus Chairman Rep. Mark Meadows, R-N.C. But while giving states more say in the health plans offered to their residents is winning the applause of conservatives, moderates seem to be leaving in numbers big enough to sink the bill.
House Ways and Means Committee Chairman Kevin Brady, R-Texas., is confident the votes will eventually come around.
“I think the hesitation has only been to be able to digest this, to be able to think about how it applies back home, before they commit their vote. The conversations that I’ve been in are very positive and we’re just going to keep working on it,” said Brady.
And despite the pressure from Democrats and the media on the timetable for getting this done, Brady says he’s less concerned about meeting a specific deadline.
“I’m a big believer in letting the consensus drive the timing. So don’t set a date. I want to deliver on my promise to repeal Obamacare: all the taxes, all the mandates, all the subsidies, defund Planned Parenthood and return control to the states. That is what I am intent on doing,” said Brady.
Brady, who played a key role in crafting the original American Health Care Act, says the current bill is an improvement.
“Centrists and conservatives sat down and said, ‘How can we make this better?’ As a result, the MacArthur amendment , as well as the Palmer amendment before it, continue to lower premiums , which is what we want for every American, gives states more flexibility to design plans that are right for the state and the community rather than Washington control,” said Brady.
Brady says if this bill can get through and Health and Human Services Secretary Tom Price acts to roll back regulations, much of Obamacare will be history.
“Getting steps one and two done with the White House repeals 90 percent of that or more and puts in place free market options but we still have more work to do,” said Brady.
“Allowing types of business to join together, to buy across state lines, to have much better options, (as well as) malpractice reform, where we get those junk lawsuits out of medicine. All of those are going to have to be standalone bills,” said Brady, noting that Senate rules cannot allow everything to be done by reconciliation, which would skirt the possibility of a filibuster.
Brady says some of the more popular provisions in the current law would stay, including no one being refused coverage for pre-existing conditions, allowing children to stay on their parents’ policies until age 26, abolishing lifetime caps and more.
Brady says it is not only vital to pass the AHCA in order to bring relief to struggling Americans, he says it’s vital for the next major priority – tax reform.
“We never anticipated in tax reform having to also repeal another trillion dollars of taxes that were included in Obamacare. All these taxes hurt the economy. They raise costs on patients. They hammer small businesses. We need them gone, but if we had to do that through tax reform, that would mean we couldn’t lower the rates as much for families or local businesses or to become competitive against China and Europe,” said Brady.
In fact, Brady believes getting the AHCA through is really the trigger for accomplishing much of the Trump agenda.
“This is all about momentum for the Republican conservative agenda in Washington. This president wants to shake things up. We need to be right there to deliver on these big changes, so building the momentum off of health care into tax reform, I think, is helpful,” said Brady.
Republicans are committed to repealing and replacing President Obama’s health care law, but one of the law’s fiercest critics warned that overhauling such a huge part of the economy will take time and might be a bit messy but will hopefully show clear results within two years by taking the federal government largely out of the health care business.
Galen Institute President Grace-Marie Turner says President Trump and congressional leaders are smart to make repeal and replacement of the Affordable Care Act the top priority out of the gate in 2017.
“The individual mandate, the employer mandate, the taxes, the Medicaid expansion all are on the table for repeal. They’re going to provide a safety net. If you’re on Obamacare now, you’ll be able to continue to keep your coverage for at least two years. After that, they’re building the bridge so that people will have better options for going forward,” said Turner.
This week, Republican Sens. Bill Cassidy, R-La., and Susan Collins, R-Maine, introduced a bill that would give the states the option of keeping the current system in place if those states’ leaders felt it was best for their citizens.
Turner says any truly effective plan would only allow the states to keep Obamacare as a transition for a couple of years.
“This whole law is not working. It’s like a house of cards. Once some parts of it start to fall, others do as well. But the money can continue to flow. That’s really the main thing states want. ‘Can you give us some money our citizens are getting through the exchanges for their subsidies and for Medicaid,” said Turner.
However, she says states may have the long term option of keeping their own exchanges in operation.
“Some of the states that have existing exchanges that they have set up may continue to use that exchange. Others may decide to do private exchanges. Others may set up a new kind of, much more flexible exchange state exchange to give people the opportunity to buy plans that are a lot more flexible,” said Turner.
She says removing power from Washington and sending it back to the states has to be a bedrock of any reform.
“It has not worked for the federal government to tell citizens of Manhattan they have to buy exactly the same coverage as somebody in rural Montana. That doesn’t work. You’ve got to have more flexibility where the states decide what kind of policies to approve that meet the needs of the citizens and the resources of the state,” said Turner.
“So the states will have a lot of leeway to use these new resources, meet goals, but not have to jump through all of these tens of thousands of pages of Obamacare regulatory hoops and instead thinking what’s the best way to solve this problem,” said Turner.
The Affordable Care Act was passed in March of 2010 but did not begin implementation until the disastrous healthcare.gov roll-out in October 2013. Turner says patience will be a virtue as Congress and the Trump administration try to turn this ship around.
“There’s a long lead time. The plans have to figure out what the states are saying are the parameters. You know, what’s considered insurance. Then they have to design their policies. Then they have to go back for approval. Then they have to start marketing them out. That can actually be an 18-month or even a two-year process,” said Turner.
Turner says hopes for much lower premiums heading into the next coverage period are not well-placed.
“They’re just not going to see any relief this year. I think that will be very hard. But they’re trying to see what they could do to speed this process up so the people have better options in 2018 at least, certainly 2019,” said Turner.
Given that Washington would have a much smaller role, Turner is confident the new policies and increased options will be available to consumers much more quickly than Obamacare was launched.
And she says the politicians can read the calendar too.
“The replace part is going to rely on markets and rely on states and make sure that people are covered in the meantime. So I don’t have that crystal ball. I wish I did, but I know that they are very motivated to show results before the 2018 elections,” said Turner.
Turner is optimistic that the states and the marketplace can turn things around. She says the creation of Health Savings Accounts in 2003 were available to consumers within weeks.
“That legislation passed in early November in 2003. On January 1, 2004, less than two months later, the first Health Savings Account was sold. That’s how quickly the market can turn around if you’re giving them new flexibility, new freedom and the ability to turn around and sell something that people actually want to buy,” said Turner.
The Obama administration is using the intelligence reports of Russian hacking influencing the 2016 campaign as the premise for asserting more power over the states in running elections, but a top election fraud expert says federal involvement would make elections more vulnerable to mischief and is really just a way to insert the federal government where it doesn’t belong.
Article I, Section 4 of the U.S. Constitution is clear about the roles of the federal and state government in overseeing elections.
“The times, places, and manner of holding elections for senators and representatives shall be prescribed in each state by the legislature thereof; but the Congress may at any time by law make or alter such regulations,” it reads.
However, on Jan.6, the Obama administration – not Congress – decided to give the government more power in running elections. President Obama has been very busy cramming in many new regulations before he leaves office, but elections expert and columnist John Fund says this one is particularly alarming.
“One of the most troublesome (orders) came last Friday and gave the federal government the power to begin centralizing our election systems. The Constitution explicitly gives states the power to set the ‘times, manner and places of holding elections,'” wrote Fund in National Review Online on Sunday.
“But Homeland Security Secretary Jeh Johnson used the excuse of Friday’s release of a report on Russian hacking of the Democratic National Committee to declare that state and local voting systems will be designated as ‘pieces of critical infrastructure’ so that the U.S. Department of Homeland Security (DHS) can protect them from hackers,” Fund continued.
Fund closely chronicles election fraud and is the author of books such as “Stealing Elections: How Voter Fraud Threatens our Democracy” and “Who’s Counting?” How Fraudsters and Bureaucrats Are Putting Your Vote at Risk.” He says this is another clear-cut case of Obama violating the Constitution to further an agenda.
“It’s once again the Obama administration reaching beyond it’s constitutional limits. The states have the authority in elections in the Constitution. If the federal government wants to intrude, wants to take over part of it, it has to negotiate with the states who are sovereign entities in their own right and come to some sort of compromise,” said Fund.
“Instead, it’s an ‘Our way or the highway’ approach and the states are naturally resentful of the fact that the federal government is now holding over them the sword that anytime there’s a problem in any election system, the federal government is aggregating to itself the power to step in and who knows what they’re going to do,” said Fund.
In addition to what he sees as a blatant violation of the Constitution, Fund says the Obama administration is taking action to address a problem that does not exist.
“The actual voting isn’t tied to the internet. It can’t be hacked, except in a very few exceptions. The voter registration rolls might be a problem because they often are connected to the internet. But that’s not the votes. So people are confusing what the hackers have been able to do with voter registration systems with the actual voting machines,” said Fund.
“If you wanted to hack them, you’d have to hack them individually one by one. You can’t do it through the internet. You can’t do it nationally,” said Fund.
So what’s really at work here? Fund says the federal government instinctively bristles at the states have sovereignty in certain areas and have recently lost power on elections.
“The feds have always been angry that the states sometimes don’t listen to them. For example, the feds lost the power just a couple of years ago in the Voting Rights Act to force 14 states to run all of their election changes through Washington. The Supreme Court said, ‘It’s been 50 years since the civil rights revolution. It’s time to let that go. If Congress wants to pass a new law, they have to do that,” said Fund.
“The feds have chafed on that because it means they can’t send monitors to certain states. They can’t intrude. They can’t physically interfere in elections unless the states invite them in,” said Fund.
He says this new rules gives them a foot in the door again.
“This means the federal government has a new excuse, now that they’ve lost the voting rights excuse. They have a new excuse to step in any time they want and dictate or second-guess what the states and counties are doing,” said Fund.
Fund is convinced that the the premise of the federal government coming in to make sure elections are not hacked is simply one step in a long-term endeavor to choke the sovereignty out of the states.
“This is a lot like the frog in the pot of boiling water. The feds are turning up the heat on the states. They hope that if they do it slowly enough and carefully enough, the states won’t be able to squawk enough. Finally, the feds will be in charge and the states will be a secondary player in elections, not the primary player as the Constitution envisioned,” said Fund.
Even before the new rule granting DHS new power to get involved with state and local elections, some states accuse the department of trying to hack their systems unannounced in 2016. Georgia is making the most noise about it. Kentucky and West Virginia have reportedly expressed similar concerns.
Fund says the details on those stories are murky.
“We know very little because the feds aren’t talking,” said Fund. “Apparently they didn’t tell the states even after they’d made the attempt. It’s one thing to make a surprise attempt to hack into a state system. It’s another thing after the attempt has been made not to tell the state about it,” said Fund.
“So once again, the feds are playing sneaky, not telling the states what they would normally be expected to tell them, and all because the feds think they know best,” said Fund.
The silver lining to the Obama administration’s action is that it can be easily reversed.
“With the stroke of a pen, it could go away tomorrow if tomorrow was Jan. 20, which is the day Donald Trump is inaugurated,” said Fund.
However, he warns not to assume Trump will scrap the new federal power right away.
“I suspect at the very least he should have his appointees ask some very searching questions about, ‘Was this really justified? Couldn’t they have worked with the states toward some sort of compromise solution? Does the government always have to bigfoot in if there’s a perceived issue involved?’ The answer to those questions is no it doesn’t. The feds should get in the habit of cooperating with the states, not commanding the states,” said Fund.
Critics contend that compromised voter registration information online ought to be a major concern. Fund says there’s an easy solution.
“The smartest way to stop hackers from getting into voter registration systems, which are online, is to stop online registration. Go back to the old system where you have to fill out a postcard and send it in. The records are kept. It’s a little cumbersome, but you can’t hack a piece of paper,” said Fund.
“I’m not saying hackers aren’t a problem,” said Fund. “I’m saying that if we keep our systems simple, don’t go to internet voting which would be a potential disaster, and if we maintain vigilance, we don’t have to surrender our traditional control of state and local elections and federal elections to Washington,” said Fund.
