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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.
Earlier this year, a $1.3 trillion dollar omnibus spending bill left many fiscal conservatives wretching over the rise in domestic spending, but Hillsdale College Prof. Gary Wolfram says mandatory spending is real emergency and we’ve got less than a decade to do something before it gobbles up all of our revenue.
Wolfram teaches economics and public policy at Hillsdale. He also served as chief of staff to former Rep. Nick Smith, R-Mich, in the mid-1990’s and on the Michigan State Board of Education.
The omnibus controversy arose when President Trump and Republican congressional leaders agreed to huge increases in domestic spending in exchange for lifting the spending caps on national defense spending.
In a recent column, Wolfram explains that mandatory spending – Social Security, Medicare, Medicaid – is the much greater threat. What makes it mandatory is specific congressional acts dictating how much is spent on those programs.
In our interview, he discussed how much federal revenue goes towards mandatory spending now and what it will look like in a few years if the problem is not addressed.
“If you look at mandatory spending plus interest on the debt, in 2019 it’s going to be 70 percent of the budget outlays and 89 percent of the revenue. So if Congress didn;t enact anything, 89 percent of the revenue’s going out the door already with mandatory spending.
“If you get to 2028, according to the Congressional Budget Office, 98.5 percent of all the revenue that comes into the federal government is going to be spent already, either through Social Security, Medicare, Medicaid, and some other items that are already mandated, plus net interest,” said Wolfram.
“So if you do not do something about Social Security and Medicare, which between them are almost two trillion dollars in 2019 and are going to be $3.3 trillion in 2028, you’re not going to do anything about the deficit,” said Wolfram.
While Wolfram believes each mandatory program must be reformed, his first recommendation is to change the appropriations process. In Wolfram’s home state of Michigan, the legislature determined how much is spent on each program every year, regardless of what is mandated in statute. He says the same principle should be applied in Washington.
“Let’s say Social Security is supposed to spend $1.043 trillion in 2019. If this were the way the Constitution worked in the federal government, Congress appropriates a trillion dollars. Everybody gets their proportionate share of the trillion dollars. I think that’s the type of thing we’ve got to be looking at,” said Wolfram.
Wolfram says Congress won’t get serious about reforming programs until members are faced with passing a massive hike on Medicare and Social Security taxes.
He ought to know. When serving for Rep. Smith, Wolfram pushed legislation that would allow taxpayers to set aside a portion of the their Social Security tax payments into a private account in exchange for receiving smaller checks when they retire. Only one other members showed up at the press conference announcing the bill.
But he says there are still measures that could do some good.
He says keeping the system in place for Americans 55 years and older is doable if younger people are told they won’t get Social Security benefits until they are 70 or 75. However, he believes Medicare needs a far more drastic overhaul.
“With Medicare, you’ve got to change the way the system works. You’ve got to make it like health savings accounts are in the private sector, where it’s a high deductible policy where you get so much and then you ask the question, ‘How much does it cost when you go to get your blood test?'” said Wolfram.
He says there are simple ways to drastically reduce Medicaid costs as well.
“Think of what the incentives are in Medicare or Medicaid. It’s to produce something that the government will pay for, even if it’s inordinately expensive, because the person buying it is not the person receiving it,” he said.
Wolfram says the health savings account approach works well on Medicaid as well.
“If you apply that to Medicare and Medicaid, it’ll change the whole incentives of the system. I’ll be Walmart or Walgreens and I’ll have a nurse practitioner there, charge you ten bucks to tell you your kid’s got pink eye and then provide you with a prescription,” said Wolfram.
Congress refuses to deal with the problem, but Wolfram still holds out hope that lawmakers will do the right thing when they have no other choice.
“I believe at some point things are going to get bad enough that they’re going to have to deal with it,” said Wolfram.
Last month, the Trump administration gave its blessing for Kentucky Gov. Matt Bevin to implement work requirements for some Medicaid recipients, and while his critics are predicting this move will result in people needlessly dying, Bevin says it will lead to better health outcomes because more people have a stake in the system.
Bevin’s predecessor, Democratic Gov. Steve Beshear, embraced Medicaid expansion as President Obama’s health law took effect. However, Bevin says that decision did not result in better health care for the people in Kentucky.
“The whole purpose of having health coverage is to, ultimately, allow people to have better health outcomes. What we have seen is through the expansion of Medicaid we actually have fewer doctors, not more, that will even see Medicaid patients, which means that we’ve made access to health care less possible, even though more people are covered,” said Bevin.
Bevin says just adding people to Medicaid isn’t even an upgrade for those who had no coverage prior to Obamacare taking effect and Kentucky agreeing to expand Medicaid.
“Studies that have been done have shown that people with Medicaid access in some instances have lesser health outcomes, at best equivalent health outcomes to people with no coverage at all. That’s a pretty sobering fact,” said Bevin.
And he says the short-term evaluation of health in Kentucky is seeing no improvement.
“Kentucky leads the nation in many health categories that we would not want to: diabetes, lung cancer, premature death, hypertension, cardiac arrest, and cardiovascular disease. These are things we don’t want to lead the nation on and these numbers have only gone up since we’ve expanded Medicaid. This tells us something isn’t working,” said Bevin.
As governor, Bevin says it is his job to make sure taxpayer dollars are providing some value for the people in the commonwealth.
“I’m a big believer in spending the money that we have and not more, being good stewards of the taxpayers’ money because it is our own money. I believe in cutting regulation, simplifying the process. But above all else as it relates to health care and any other policy that comes from government, we have to look at what the return is that we get on investment,” he said.
“So as it relates to this issue and everything else, my approach to governing is to get a good return for the taxpayers on their money and to get results. At the end of the day, that’s what wee should be paying for,” said Bevin.
Bevin says it is clearly in the interest of Kentucky to change its approach to Medicaid, and he wants to make it in the interest of each person in the Bluegrass State.
“If people have a vested interest in something, because they have actively participated in it, then they’re more likely to value it and utilize it. The analogy I’ve often given is for people who have bought their own bicycle. The odds are pretty high that they didn’t leave that bicycle out in the rain. In other words, if you care about something, you’re going to pay better attention to it,” said Bevin.
He is also quick to point out that the new policy applies to a fairly small percentage of Medicaid recipients.
“This doesn’t apply to anybody who is a traditional Medicaid patient: the elderly, the frail, someone who’s pregnant, a child, someone who has a disability, who is addicted to drugs. These are people for whom there is not an expectation. These are people for whom Medicaid was originally designed.
“What it wasn’t designed for is working-aged, able-bodied men and women, people with no dependents, people who could get engaged but for some reason have not. That’s not who this system was designed for so this waiver, this expectation that people work, or volunteer or get training or get education only applies to a small subset of the expanded Medicaid population,” said Bevin.
He estimates that 60 percent of those in the expanded Medicaid pool already comply with the requirements, which is to work, volunteer, train, or get education for 20 hours per week – either all in one area or in a combination of two or more categories.
So what impact could this have in Kentucky?
“As we have done projections, and they are only that, we would expect that five years from now there might be as many as 95,000 current recipients who are no longer needing Medicaid for one of two reasons. A, they have moved their way up and out and that should be the bulk of them. And B, they just don’t want to do anything at all in exchange for something of value,” said Bevin.
Liberal critics are savaging Bevin for pushing work requirements, alleging that people will end up dying because those standards could not be met. In addition to the statistics comparing Medicaid coverage versus no coverage, Bevin points out that grew up in deep poverty and never had health coverage until he joined the military.
He also says Center for Medicare and Medicaid Services Administrator Seema Verma articulates his approach to the issue perfectly.
“[She] said that to do other than this is to treat those who are poor with the soft bigotry of low expectations. That is perfectly said.
“I find it offensive that liberals think that poor people can’t do things for themselves and need to be wards of the state. That’s offensive. I find that kind of bigotry to be reprehensible, and in Kentucky, we’re not going to tolerate it. We’re going to give people a better opportunity,” said Bevin.
Donald Trump became the first sitting president to address the March for Life on camera Friday, hailing the pro-life activists for their love and concern for the unborn and their mothers and announcing new pro-life policies impacting conscience protections for the medical community and flexibility for how states spend Medicaid dollars.
On a sunny Friday that was considerably warmer than most recent days in the nation’s capital, tens of thousands of pro-life demonstrators descended on the National Mall to hear speeches from President Trump, Vice President Mike Pence, lawmakers, and other activists before marching to the U.S. Supreme Court to denounce the Roe v. Wade and Doe v. Bolton decisions handed down 45 years ago this month by the nation’s highest court.
Those decisions legalized abortion across America, giving women protection under the law to terminate their unborn children for any reason at virtually any point in their pregnancies.
The March for Life began soon after, but for the first 44 years no president addressed the crowd in person.
That changed on Friday.
“Today I’m honored and really proud to be the first president to stand with you here at the White House to address the 45th March for Life,” said Trump.
Trump spoke from the Rose Garden at the White House. Video was then transmitted to giant screens on the National Mall. Previous pro-life presidents spoke to the march through phone calls.
Vice President Pence introduced Trump as the most pro-life president in U.S. history. Trump says protecting life is a major priority of his administration.
“Under my administration, we will always defend the very first right in the Declaration of Independence and that is the right to life,” said Trump.
Trump then listed multiple policy moves and priorities, starting with an order he issued Friday for the medical community.
“We have just issued a new proposal to protect conscience rights and religious freedoms of doctors, nurses, and other medical professionals,” said Trump.
He also announced an end to an Obama administration directive on how states can spend Medicaid dollars.
“I have also just reversed the previous administration’s policy that restricted states’ efforts to direct Medicaid funding away from abortion facilities that violate the law,” said Trump.
States may now have the flexibility to refuse sending taxpayer dollars to the likes of Planned Parenthood. In 2016, the Obama administration warned states that refusing abortion providers that money may be a violation of federal law.
Trump also urged the Senate to follow the lead of the House and approve a federal ban on most abortions after 20 weeks of pregnancy. The legislation is known as the Pain Capable Unborn Child Protection Act.
“I strongly supported the House of Representatives’ pain-capable bill, which would end painful late-term abortions nationwide. And I call upon the Senate to pass this important law and send it to my desk for signing,” said Trump.
Earlier on Friday, the House passed the Born-Alive Abortion Survivors Protection Act. The bill calls for criminal penalties for doctors who fail to treat and care for infants who survive attempted abortions and fully emerge from their mothers.
Penalties include criminal fines and up to five years in prison. Current law requires physicians to care for such babies but does not detail penalties for those who refuse.
The bill passed the House 241-183. All but six Democrats opposed it. All Republicans supported it, however, Democrats are planning to kill the legislation in the Senate.
During his speech, Trump railed against America’s standing as being among the nations with the most radical abortion laws.
“As you all know, Roe v. Wade has resulted in some of the most permissive abortion laws anywhere in the world. For example, in the United States, it’s one of only seven countries to allow elective late-term abortions, along with China, North Korea, and others,” said Trump.
“Right now, in a number of states, the laws allow a baby to be [torn] from his or her mother’s womb in the ninth month. It is wrong. It has to change,” said Trump.
Trump acknowledged the marchers and praised them for keeping the pressure on government for 45 years and counting since Roe v. Wade.
“Today, tens of thousands of families, students, and patriots and really great citizens gather here in our nation’s capital. You come from many backgrounds, many places, but you all come for one beautiful cause: to build a society where life is celebrated, protected, and cherished,” said Trump.
“The March for Life is a movement borne out of love. You love your families, you love your neighbors, you love our nation, and you love every child -born and unborn – because you believe that every life is sacred and that every child is a precious gift from God,” said Trump.
In addition to applauding those who fight to save unborn lives, Trump also praised those who care after women in crisis pregnancies.
“I want to thank every person here today and everyone across our country who works with such big hearts and tireless devotion to make sure that parents have the care and support they need to choose life,” said Trump.
Trump singled out Mariana Donadio of Greensboro, North Carolina. Donadio found herself in a crisis pregnancy when she was 17 years old chose to have her baby with the support of her parents. Now the mother of six, Donadio run Room at the Inn, a facility caring for other women facing unplanned and uncertain pregancies.
“Over the last 15 years, Room at the Inn has provided housing, child care, counseling, education, and job training to more than 400 women.
“Even more importantly, it has given them hope. It shows each woman that she is not forgotten, that she is not alone, and that she now has a whole family of people who will help her succeed.
“That hope is the true gift of this incredible movement that brings us together today. It is the gift of friendship, the gift of mentorship, and the gift of encouragement, love, and support,” said Trump.
He says that spirit is the key to ultimately winning the battle for the right to life in the United States.
“We are protecting the sanctity of life and the family as the foundation of our society. But this movement can only succeed with the heart and the soul and the prayer of the people,” said Trump.
Jim Geraghty of National Review and Greg Corombos of Radio America are pleasantly surprised to see incoming Democratic Virginia Gov. Ralph Northam back away from pushing Medicaid expansion, much to the consternation of liberals. They also shudder as a new generic poll of voters suggests Republicans are in for a very rough 2018, as Democrats lead big among women and young people and even hold slight edges among men and senior citizens. And Jim sounds off on actor Matt Damon’s insistence that he never knew about any of Harvey Weinstein’s alleged sexual assaults and harassment.
Senate Republican leaders revealed their closely guarded health care bill on Thursday, predictably outraging Democrats and leaving some conservative senators insistent that the bill doesn’t go far enough.
Known officially as the Better Care Reconciliation Act of 2017, the legislation kills Obamacare’s individual mandate, scraps many of the current taxes on the books, and gives more power to the states to define the health care market.
On the flip side, the bill increases subsidies over what House Republicans approved last month and offers a slower phasing out of Medicaid expansion. Both plans keep the Obamacare provisions of forbidding insurance companies from rejecting patients with pre-existing conditions and allowing young adults to stay on their parents’ policies until age 26.
Some of the top conservative health care policy leaders are effusive in their praise. Foundation for Research on Equal Opportunity President Avik Roy says, “If it passes, it’ll be the greatest policy achievement by a GOP Congress in my lifetime.”
Galen Institute President Grace-Marie Turner also likes the plan, noting that it addresses the four areas she believes must be dealt with as a result of Obamacare’s many problems. Specifically, she says any final product must provide a safety net, create a bridge to new coverage, allow states greater flexibility on regulations, and reform Medicaid.
“This bill does all four of those key things,” said Turner. “Yes the Senate moves the dials in slightly different ways and they learned from the reaction to the House bill, particularly in the way the refundable tax credits were structured for people who need help in purchasing coverage.”
Turner admits the Senate bill spreads taxpayer dollars around more liberally than the House plan.
“Young people, people that are in lower income categories and people (nearing) Medicare age will get more help than they would have through the House bill,” said Turner.
That approach extends to Medicaid as well.
“It gets back to a more normal way of spending the federal-state match for Medicaid spending, but it does it over a longer period of time. So the states have more time to adjust to reductions in their Medicaid payments,” said Turner.
“But they are also going to have a lot more flexibility with this bill than they would have otherwise had. Obamacare just basically added millions more people to a faltering Medicaid program instead of building in reforms,” she added.
While many on the right see the legislation as a significant improvement over the status quo, some changes must be made if Republican leaders want the votes needed to pass it. Sens. Ted Cruz, R-Texas, Mike Lee, R-Utah, Rand Paul, R-Kentucky, and Ron Johnson, R-Wisc., say they cannot back the bill in its present form because it doesn’t do what the GOP promised to do the past four election cycles.
“Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor,” the senators said in a joint statement.
“There are provisions in this draft that represent an improvement to our current healthcare system but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their healthcare costs,” they added.
Turner says she is encouraged by the language of the statement and expects their concerns to result in a stronger bill.
“I think the leadership knows they are going to have to make tweaks and adjustments to this bill. Fortunately, we’re now sort of out of the policy realm and we’re in the vote-buying realm. ‘What do you need, Sen. Paul? What do you need Sen. Johnson, etc. to be able to vote for this bill,” said Turner.
“We saw on the House side they made it better when people started to push back strongly,” said Turner.
She also says the underlying arguments from the four senators are spot on but she says the parameters for moving this legislation make things more complicated.
“They are right that we’ve got to do more to get costs down and to give people more choices. But they’re also so constrained by this process they have to go through, this reconciliation process, to be able to pass this with 51 votes, means that everything in the bill has to directly pertain to federal spending and federal taxation,” said Turner.
“That means that it’s really hard to get to the regulatory structures through this bill, which is why I think we need to think about this as a first step – breaking the logjam – so we can begin a process of making changes that effect this one-sixth of our economy so that we can begin to move forward to give people the choices that they want. but we can’t do it on the Obamacare platform,” said Turner.
Turner says with Medicare and Medicaid on the books, the conservative goal of wrenching health care away from the clutches of government will remain just that. However, she says the key provisions allowing more latitude to the states is a major step in the that direction.
“There’s always going to be a federal footprint. The question is whether it’s Bigfoot and it crushes the health sector or whether it has an appropriate footprint of helping people in need while allowing the private market to work,” said Turner.
The greatest howls of protest came from Democrats, who denounced the bill as cruel and likely to kill many people the moment it was released.
“That sort of tells me they were against it before they even knew what was in it,” said Turner.
While fully aware of the partisan divide in Washington and the Democrats’ intention to defend President Obama’s signature domestic achievement, Turner is stunned that Democrats are fine with what Obamacare is doing to health care right now.
“Are they really defending Obamacare, that has caused health insurance costs to double for an individual since the year before this law was passed, 140 percent higher for families. You have many counties that are at risk of having no options for people to use. Obamacare has not worked,” said Turner.
“There have been no changes in any meaningful way, other than one regulation, for the Trump administration or this Congress to precipitate this. This is failing of its own right,” said Turner.
Given the current numbers in the Senate, Turner believes this legislation is about the best the GOP can do on its own and that lawmakers must act.
“This is a rescue effort and they’ve got to get this done,” she said.
President Trump’s budget proposal for the coming fiscal year is coming under fierce criticism from Democrats and the media but a House Budget Committee member who spent 20 years as a college economics professor is impressed by Trump’s goals while warning that the president will need to address entitlement spending at some point.
The Trump administration released it’s $4 trillion budget proposal while Trump himself was overseas. It calls for robust increases in national security spending while calling for considerable cuts to various government departments. Democrats have labeled the budget as cruel and likely to cause children to die. Republicans warn the final appropriations bills probably won’t look much like the Trump plan.
Rep. Dave Brat, R-Virginia, spent 20 years as an economics professor at Randolph Macon College. He believes Trump is generally on the right track.
“Overall, I’m impressed, It’s got the big pieces in the right place,” said Brat. “The major piece I like is the policy aimed at getting three percent growth. That will solve a lot of problems going forward,” said Brat, while praising the policies Trump is clearly emphasizing in the budget.
“It pluses up the military. It tries to clean out the swamp. It reduces some bureaucracy. It balances in 10 years. All of these are good conservative policies,” said Brat.
Brat says the Trump plan is a great improvement over what the Democrats are proposing. In fact, he says they have no solutions at all.
“As a visionary document, we’re moving in the right direction. Across the aisle on the Democrat side, they haven’t even ever put forward a budget that balances, not even in a 75-year window,” said Brat.
Brat and other Republicans admit getting what they want in the appropriations process won’t be easy since Senate rules require at least eight Democrats to approve any spending bills. But while Democrats can gum up the process, Brat is acutely aware that voters will not accept failure when it comes to fiscal discipline.
“We should compromise but we shouldn’t give away the store. In my view, the other side has given away the store too often. On our side, we need to clean up some of this, rearrange the (entitlement) programs so the kids get sustained benefits over their lifetimes. We’ve got to get the economy moving and some of that requires discipline,” said Brat.
“So our side gets hit hard but we need to step up to the plate and take it. That’s our job and the American people expect us to get it straight,” said Brat.
But what about Democrats alleging children will die as a result of the Trump budget? That allegation was especially targeted towards a proposed $800 billion in Medicaid cuts. Brat says that’s dishonest reporting of the facts.
“The Democrats call them cuts. They’re cuts from the baseline. Medicaid still keeps increasing. It just doesn’t increase at the pace it was going at, and that pace is bankrupting the country,” said Brat. “Lot of politics going on right now but not much substance offered by the other side. They’re great at hurling the insults but they’re short on the economic studies,” said Brat.
He also says White House Budget Director Mick Mulvaney made it very clear how he want about finding places to cut in the Fiscal 2018 budget.
“He said, ‘Look, there’s no mystery. It’s just like running a business. You look at each of these programs one by one by one and you compare the benefits against the cost.’ He made it very clear the safety net is not in question,” said Brat.
Brat says Democrats and Republicans need to realize that calling for a trillion dollars in cuts is just the tip of the iceberg.
“Some on the left are giving us a hard time over trying to save a trillion dollars or so, but even if we save one trillion that leaves you with another hundred trillion dollar shortfall with Medicare, Social Security, Medicaid, etc,” said Brat, who says failure to address the key entitlements will make 10-year spending cuts seem like loose change.
“Either you reform them and update them or else the kids get nothing. The left is acting like ‘draconian’ cuts are going to hurt people. Those cuts are nothing in comparison to the mandatory piece,” said Brat.
He says the clock is ticking loudly and time is short before entitlements engulf the entire budget.
“Those mandatory programs will account for 100 percent of all federal revenues in about 15 years. That’s not a typo. All federal revenues will be spent only on the mandatory. That means there’s no money for the military, transportation, running government,” said Brat.
With that kind of looming fiscal crisis, Brat says the only path forward is to get every able-bodied adult into the workforce, and that’s where tax reform and tax cuts come in. He says the demonizing of so-called supply side economics is bizarre.
“That term is used as a pejorative right now in D.C., supply-side tax cuts. I taught economics for 20 years. The demand side is all the people out there called consumers. The supply side is also everybody out there that works for a living in business. That’s the supply side,” said Brat.
He says it’s time for Washington to embrace the supply side again, since pumping up the demand side was a major flop.
“We’ve tried demand side stuff. We’ve had bailouts, etc. that pumped money back into people’s pockets. It gives you an instantaneous jolt, but if you’re serious about getting the economy growing you better incentivize business. Trump probably won the election on that,” said Brat.
Brat believes doing tax cuts and tax reform right will set the stage for economic growth, which is the best hope for avoiding fiscal disaster in the near future. He says tax cuts give businesses reason to hire, thereby beefing up the labor participation rate and bringing in more federal revenues through taxes.
“If we solve that one it’s huge,” said Brat. “I think a lot of the worries go away if we get this economy rolling again.”
Conservatives and liberals are savaging the House Republican health care plan, but one of the leading advocates for a market-driven approach says the bill is a good start to imploding Obamacare and setting the stage for additional conservative reforms.
The plan is getting hammered by conservatives for not fully repealing the 2010 Affordable Care Act, failing to allow the purchase of coverage across state lines, and for allegedly replacing one entitlement program with another. Liberal critics say the plan would knock millions of Americans off health insurance and leave them one illness from bankruptcy again.
So what about those claims?
Galen Institute President Grace-Marie Turner is a veteran of Washington health care debates and was a fierce opponent of the Clinton health care reform effort in the 1990’s and Obamacare since 2009. She is encouraged by what she sees in the American Health Care Act and says the realities on Capitol Hill force this kind of legislation.
“It’s a first step. They’re pushing as far as they can with the process they have to go through. They do not expect any Democrats, in the House or the Senate, to vote for this. That means they have to do this through a particularly difficult process called reconciliation that limits the kinds of things you can repeal,” said Turner.
“They can’t repeal everything in the law through this process because it has to have direct spending and budget implications. They’re doing as much as they can and they have plans to go forward with other pieces of legislation, for example, that will allow people to purchase health insurance across state lines. That’s not possible through this particular pathway,” said Turner.
She says this legislation is needed to gut the worst parts of Obamacare.
“There will also be follow-on legislation going forward, but not if this [doesn’t pass]. You can’t build change on the crumbling infrastructure of Obamacare. You’ve got to begin with changes that lead us in a new direction,” said Turner.
“It’s like a battleship or an aircraft carrier. It takes a long time to turn this around ,” she added.
Turner also says a lot can be done to ease the burden on all Americans without involving Congress. She says Health and Human Services Secretary Tom Price can accomplish a lot through the powers granted him in the original Affordable Care Act.
“Sec. Price has control of the regulatory mechanism. There were 20 million words of regulation written to enforce Obamacare. He has the power to undo a lot of those and to rewrite them but also to provide new guidance to the marketplace to engender much more competition and consumer choice,” said Turner.
Sec. Price outlined the very same strategy Tuesday at the White House.
Turner says the GOP bill offers important provisions like eliminating a trillion dollars worth of taxes on the economy and protecting coverage while the system transitions from Obamacare. She also says the bill takes a smarter look at Medicaid dollars that should mean less burden on the taxpayers.
“It begins the pathway to reform the Medicaid program, arguably one of the worst health care programs in the country that is bankrupting the states. At the same time, millions of people (on Medicaid) can’t find a doctor to see them,” said Turner.
And how would it do that?
“This legislation would begin the process of giving states a per capita allocation. A per capita allocation is very different from a block grant. It basically says we are going to make a distinction between moms and babies who are healthy and people who have multiple disabilities,” said Turner.
She also likes that states will have much more say over health care while Washington backs off.
“It gives states more power and more authority, not only to figure out how to take care of their citizens that are on Medicaid, but also to provide their citizens with more choices from the kind of health insurance that they want to buy, rather than have the federal government tell them the health insurance they have to buy,” said Turner.
But will the plan ultimately lower premiums and deductibles? Turner says that hinges on getting people to stay on insurance for the year once they’ve purchased it and getting more, young healthy people into the system.
“You need young, healthy people in the system. What do you do? You try to give them more choices, more options of more affordable coverage. So attracting people, giving them incentive to want to stay covered, by giving states more options to provide them with choices for health insurance – not just Washington’s three or four cookie-cutter policies,” said Turner, who also advocated for multi-year policies so patients could lock in rates for years at a time.
While acknowledging the fierce opposition to the plan from the right and left, Turner says the bill not only makes key changes but looks at health care in a whole new way.
“It’s a really different philosophy of giving people the market incentive to respond to consumers who are newly empowered and want to make responsible, good choices,” said Turner. “People want insurance but they don’t want insurance that costs more than their mortgage.”
This is one of multiple perspectives we will be sharing on this legislation as the debate continues.