Obamacare
House Conservatives Push Quick Action on Obamacare
The conservative House Freedom Caucus is pushing for quick congressional action to repeal and replace the Affordable Care Act and says the plans it supports will mean better coverage, lower costs and more control for patients.
And House Freedom Caucus Chairman says if Republicans don’t follow through on their promises to repeal and place the law, voters ought to send them packing next year.
“I am confident we can do that, and I am confident that if we don’t do that, everybody should send us home and they would have every right to send us home if we don’t deliver on a real promise to make it affordable,” said Rep. Mark Meadows, R-N.C., who leads the House Freedom Caucus in the current Congress. “We promised to do that. We’ve got to deliver.”
Reports vary widely as to how soon Congress may tackle the repeal, with some lawmakers wanting to get it done in President Trump’s first 100 days and others thinking repeal and replacement may not be completed until later this year or even early 2018.
Meadows says the GOP consensus is to get this done quickly, but a debate is brewing about whether to repeal now and replace later or pass the two bills at the same time.
“It’s that replacement plan that really is providing a great anxiety among some of the Republican members, what it should include and what it shouldn’t include. There’s still some disagreement there but I’m optimistic that we will go ahead in the next 30-45 days and vote on something in the House and the Senate and move this along,” said Meadows.
“If it waits until next year, it won’t get done, so [Americans] need to weigh in with their member of Congress to say, ‘We want them to act now,'” said Meadows.
Meadows also rejects the idea of allowing the current system to fester for another year as a means of building public demand for repealing and replacing current law.
“I can tell you from a principle standpoint, to suggest that we allow it to continue to spiral down so that more people are hurt is not something that would be prudent,” said Meadows.
But Meadows also dismisses the alarm from Democrats that repealing Obamacare will means tens of millions of Americans will lose their coverage.
“The Affordable Care Act, the way it is now, is not sustainable. A lot of those people who may have gotten coverage won’t be able to keep their coverage on the current trend,” said Meadows.
Many of those Americans who now have coverage got it through the expansion of Medicaid. Meadows admits that will be one of the thornier issues to navigate.
“It is a critical component that we have to address in some shape, form, or fashion. But whether they get this done with block grants on a per capita basis or some other mechanism, I believe that we can come up with a workable solution that doesn’t leave anybody behind and provides an adequate safety net,” said Meadows.
Last week, the House Freedom Caucus threw its support behind legislation from Sen. Rand Paul, R-Ky., that is designed to repeal the current law and simultaneously replace it with legislation that will patients much more freedom in choosing their coverage. Paul is fiercely urging GOP leaders not to blow a hole in the deficit by repealing the law and only then getting to work on a replacement.
Rep. Mark Sanford, R-S.C., is offering a companion bill in the House that Meadows says goes a step farther than Paul’s approach in the effort to break up monopolies in the insurance market.
Meadows says there are some must-haves for conservatives in any replacement legislation.
“It’s one of the few plans that is out there that won’t blow a hole in the deficit, actually will bring down costs, and hopefully will not only address the concerns about pre-existing conditions that many of my constituents and people across America have been concerned about, but do it in a way that actually drives the cost of health care down,” said Meadows.
Meadows says the final legislation needs to require insurers to cover people with pre-existing conditions and forbid carriers from cancelling policies when people get sick. He also wants more flexibility and freedom for people in their Health Savings Accounts, but is shying away from mandating that children be allowed to stay on their parent’s policies until they are 26 years old.
“We think the private sector can actually address that probably better than making it a mandate,” said Meadows, who also strongly endorses a plan from Sen. Paul to provide tax deductions for doctors who work a lot with low income patients.
“They don’t get to write that off now, so this will actually be an incentive to provide health care on a more philanthropic basis,” said Meadows.
Meadows says the cooperation between the White House and Congress has been excellent and that GOP leaders are showing respect for conservative ideas and strategies. At the same time, Meadows expects an intra-party clash over tax credits.
“Probably the biggest stumbling block right now is the leadership’s desire to use an advanceable, refundable tax credit, where a number of us probably don’t feel that’s the best approach to address it,” said Meadows.
Meadows urges his fellow Republicans to move intelligently but swiftly towards their top legislative priority. He says lawmakers need to stand on principle and let the political chips fall where they may.
“I think it’s more important that we act now to put forth not only a repeal but a replacement of all of it and make the tough decisions. As members of Congress, if we make the right decision and it sends us home, so be it,” he said.
Three Martini Lunch 2/15/17
Jim Geraghty of National Review and Greg Corombos of Radio America react to the IRS reportedly ignoring whether taxpayers failed to purchase health insurance in 2016. They also discuss the latest revelations surrounding Mike Flynn and the leaking to the media by career national security personnel. And they discuss the early speculation that Kid Rock may be recruited to run for U.S. Senate in Michigan.
Brat: Tax Reform Must Come First
Members of the conservative House Freedom Caucus are pushing party leaders to speed up work on major legislative priorities and stay committed to their campaign promises, but one key member says the effort should begin with tax reform and not Obamacare.
As the first 100 days of the Trump administration tick by, conservative lawmakers are urging leaders in the House and Senate to get going on their vows to repeal and replace the Obama health care law and jump start the economy with significant tax reform.
Rep. Dave Brat, R-Va., shot to conservative stardom when he topped then-House Majority Leader Eric Cantor in a 2014 congressional primary. A former college economics professor, Brat says getting tax reform done first and done right are at the top of his priority list.
He says news that top Republicans plan to address health care and infrastructure before the tax code is a mistake.
“That is hugely concerning. I taught economics for 20 years. That is piece number one, without which I can’t vote for anything else,” said Brat.
Specifically, Brat wants to see a major reduction in the corporate income tax rate and immediate expensing for business. He says that is the key to getting the economic engine humming. He says experts who helped to craft the 1981 Reagan tax cuts, such as Arthur Laffer, see those provisions as they keys to explosive growth, wage growth and job creation.
“He said that is consistent with eight percent wage growth, four percent GDP growth for the country and eight percent wage growth for a country that has not seen the average guy have their wages increase for 30 years,” said Brat.
He says getting that right will set the stage for everything else.
“If we don’t get that piece, we will not be able to afford any of the rest of it. That has to come first. It’s got to be in writing. It’s got to be in stone or I can’t go along with the rest of it,” said Brat.
As for Obamacare, conservatives have two growing concerns: moving more quickly to advance legislation and pushing hard against some GOP leaders who now seem willing to work within the framework of Obamacare than to repeal it in full.
Brat says part of the current delay on legislation is due to the Senate slow-playing the confirmation of Rep. Tom Price, R-Ga., to be the nest Secretary of Health and Human Services. The congressman says President Trump has made it clear that is the key to revving up the reform effort.
“A few weeks ago, he said, ‘Look, once Price is in that slot, then we’re going to move at lightning speed.’ So I think that’s what you can realistically hope for. Once Price [is confirmed], boom, the plan comes out and we run with it. I think it’s going to be surprisingly good,” said Brat.
“I don’t think it will be perfect. I’m not a big fan of tax credits because you can bid those up forever,” said Brat. “But it will not be Obama-lite from what I’m hearing.”
An aggressive approach in the House, however, may run into hesitation from Senate Republicans, who seem more willing to work within the existing framework of Obamacare.
“The Senate has made it clear they’re OK with tweaking Obamacare and repairing the existing broken system. I obviously think that’s the wrong way,” said Brat.
Brat says Gov. Scott Walker, R-Wis., is coming to rally the GOP members to stand strong on campaign promises to repeal and replace Obamacare.
“[Walker] says, ‘Once you start reform, you can’t backtrack. Once you take out one leg of the stool, which we already have done – Trump has already done some of the repeal by regulatory fiat. Once we start down that road, we’ve got to conclude it. I think (House Speaker) Paul Ryan is going to to come out and make that clear in the next few days,” said Brat.
Brat says the tinkering approach cannot work. He points out that the typical family on just a bronze plan is saddled with a $12,000 deductible just to get access to the health care system. As a result, he says it’s putting even greater financial pressure on Social Security, Medicare, Medicaid and veteran’s programs, which are now headed towards insolvency faster and faster.
The congressman says the current system bends the cost curve up by 20 percent for Americans. He says the only responsible approach is to bend the cost curve to zero in order to spare those programs and give younger Americans a fighting chance of actually seeing some of those benefits.
“We’re growing (the cost curve) at 20 percent now. Bending the cost curve down doesn’t mean you grow at 10 percent or five percent. It means you shrink the cost of health care to zero. That’s what you’ve got to do just to maintain balance. That doesn’t reduce costs. That just keeps them from growing more in the out years. So we’ve got some heavy lifting to do,” said Brat.
Three Martini Lunch 2/6/17
Jim Geraghty of National Review and Greg Corombos of Radio America have all bad news, starting with a federal judge putting a hold on Pres. Trump’s immigration order without citing any law or constitutional provision and Trump’s subsequent tweets attacking the judicial system. We also blast Trump for his moral equivalence in dismissing Vladimir Putin as a killer by saying America’s done a lot of bad things too. And we discuss and debate whether the slower GOP strategy on Obamacare and tax reform is responsible leadership or letting a golden opportunity slip away.
The Road to Repeal and Replace
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.
Trump Order Weakens Obamacare
While the White House press corps pores focuses on how many people showed up on Inauguration Day, President Trump’s first executive order is already weakening Obamacare in preparation for the repeal and replace effort in Congress in the coming weeks.
The order instructs all relevant agencies, primarily the Department of Health and Human Services, to “ease the burden” of Obamacare. If that sounds vague, that’s exactly how it was intended.
Health care policy expert Dr. Merrill Matthews of the Institute for Policy Innovation says the lack of specifics means a lot of actions can be taken to protect patients.
“Departments and agencies with control over Obamacare under the Affordable Care Act ‘shall exercise all discretion and authority available to them to waive, defer, grant exemptions or delay the implementation of any provision in the act,'” said Matthews.
“They can also relieve the states of cost, fee, tax, penalty or regulatory burdens on individuals, families, health care providers, health insurers, patients, recipients and so forth and so on,” said Matthews.
So what does all that mean?
“It’s a very broad statement, which says those people who are in charge, basically the secretaries – primarily of Health and Human Services but perhaps also the IRS and maybe a few other agencies, have the freedom under this executive order to try to step in and say, ‘We’re going to try to reduce the burden of Obamacare with respect to mandates, penalties and taxes,” said Matthews.
And despite Obamacare being passed by Congress, Matthews says the way it was written allows the Trump administration to take the teeth out of the law even before Congress acts.
“There was nearly 3,000 references to the word secretary in the Affordable Care Act. Nearly all of those apply to the secretary of Health and Human Services. The language was, ‘The secretary shall determine,’ ‘the secretary shall decide,’ ‘the secretary shall set penalties’ and so forth. The law itself gave the secretary of Health and Human Services a lot of discretion to carry this out,” said Matthews.
“I would argue that the ability to provide all that power to the secretary to implement the law also provides a lot of power to the secretary to un-implement the law,” said Matthews.
Matthews says Trump is exercising “transitional authority,” a power that Obama claimed when changing or delaying certain components of the law. It’s something Matthews says Obama became quite brazen about.
“President Obama had moved the situation to the point where he said in a speech, ‘I’m going to do what I feel like needs to be done out there. If Republicans don’t like it, sue me,'” said Matthews.
Republicans cried foul at the time, but Matthews says this usage is only undoing what Obama shouldn’t have been able to do in the first place.
“Once they set the precedent, it’s hard to be too critical of it. Conservatives felt like that was overreaching. But if [Obama] overreached, I’m not sure it’s bad overreaching to pull it back and say, ‘You never had the authority to do that.’ We’re in essence bringing it back to the status quo ante,” said Matthews.
Matthews also points out that this will take place in a very brief window before Congress acts to repeal and replace the law.
“This is very temporary and it’s meant to begin relaxing these burdens while Congress takes action to actually repeal and replace the legislation,” said Matthews.
In addition to easing the burden of the law before Congress gets to work, the executive order stands as a message to Congress. Matthews says Trump is asking lawmakers to follow his lead.
“The executive order that Donald Trump released in essence says, ‘Here’s the flag. I’m showing you where I’m going on this. You have my permission to begin to scroll this thing back as far as you can within the limits of the law,” said Matthews.
‘We Have A Once in A Century Opportunity’
Congressional Republicans began the process to repeal and replace the Affordable Care Act last week and Rep. Dave Brat, R-Va., says the party needs to keep moving with urgency towards fulfilling the GOP’s top campaign promise.
“We have a once in a century opportunity for real to get this right. Medicare and Social Security are insolvent in 15 years if we don’t get this right. The kids will be left with nothing,” said Brat, a former college economics professor. “I taught those kids for 20 years at the college level. That’s why I got into this business, to make sure we get this right.”
“We promised the American people this repeal and replace. It’s our number one promise since 2010,” said Brat.
Brat says some people are mistaken in believing that the votes Congress took last week already repealed the law.
“All we did last week was have the budget resolution vote. You have to have a budget to move forward on what’s called reconciliation,” said Brat. “Reconciliation is what allowed Obamacare to be passed in the first place with just 51 votes in the Senate.”
“Now Republicans are going to use the same reconciliation process to repeal and replace,” said Brat.
Much of the talk on the GOP side centers on whether to have the repeal take effect in two or three years. Brat hopes it’s much sooner than that.
“Some folks are getting a little wobbly. The problem with the two-year is that will occur as our re-election occurs. So politics is going to get mixed in with policy and that’s never a good model to do what’s in the best interest of the country,” said Brat.
He says waiting three years to trigger he repeal is an even worse idea since the 2020 presidential race will already be underway.
Brat says some congressional Republicans are getting skittish about moving so quickly and passing a repeal without a formal replacement attached.
“The details of that have not been worked out to put it mildly, so there’s a little angst from all sides on that. What’s the repeal going to look like? What’s the time frame? Is it going to be done in two years or three years and what’s the replacement?” said Brat.
Brat dismisses claims by Democrats that repealing Obamacare will take coverage away from up to 30 million Americans, calling it “nonsense.”
“People are nervous about being left in the lurch. They shouldn’t be. There’s all sorts of plans out there that show we’re actually going to end up with a better product,” said Brat.
What is unsustainable, says Brat, is the soaring cost of health care for Americans right now. He says the typical family pays $17,000 in premiums a year for coverage while still confronting much higher deductibles. He is working with Sen. Jeff Flake, R-Ariz., on expanding Health Savings Accounts. Brat says allowing people to choose simple catastrophic plans while building up their Health Savings Accounts would provide peace of mind while also showing people the exorbitant cost of health care.
Brat also says ideas like allowing people to pool together can bring down costs.
As Republicans throw out different ideas, Democrats often allege that seven years after Obamacare was passed, Republicans still don’t have an alternative.
“The Democrats say we don’t have a plan. That’s true. We have nine of them,” said Brat, who doesn’t expect the GOP to take long in compiling a replacement.
He says it’s the Democrats who have their heads in the sand.
“The entitlements, Medicare and Social Security, are going insolvent and not a word from the Democrats’ side on these major issues, when the kids will end up with no systems whatsoever in 50 years. Not a word, just crickets,” said Brat.
But the start of the repeal and replace effort also has Republican critics. Sen. Rand Paul, R-Ky. and other Republican fiscal hawks are pointing out the budget used to trigger the reconciliation process blows a $9.7 trillion hole in the budget and adds greatly to an already out of control national debt.
Brat, who voted for the resolution, says Paul and his allies are technically correct.
“They’re right. We chose the current CBO baseline and it blows huge holes in the budget. I think that was done to offer the Senate a little bit of latitude to get the vote right here,” said Brat.
But Brat, a member of the House Budget Committee, says GOP budgets will fix that in the coming months.
“We’re going to do another budget in four months and that one will get back to normal balancing in ten years, maybe sooner than that,” said Brat. “That’s the hope of some of us.”
‘A Conservative, Solution-Oriented Agenda’
The new chairman of the conservative House Freedom Caucus is promising one of the most consequential starts to a presidential administration in modern history, as Republican stand poised to run Congress and the White House.
Rep. Mark Meadows, R-N.C., made headlines in the last Congress for filing the resolution that led to the resignation of former House Speaker John Boehner, R-Ohio, in 2015. Now he says House conservatives are ready to make significant contributions on a wide range of issues.
“It’s really pushing that conservative, solution-oriented agenda so that the Senate take notice and understands that watered-down, business as usual kid of decisions aren’t going to happen,” said Meadows.
“Whether it’s on securing our border, whether it’s looking at the Syrian refugee issue, whether it’s pushing back against an anti-Israel UN, they’re going to get the opportunity to take votes and make the important decisions that are important to your listeners that are our constituents as well,” said Meadows.
And despite previous clashes with GOP leaders over spending and who sits in the speaker’s chair, Meadows is confident that leaders are listening to conservatives on key issues.
“I have seen a real willingness on behalf of this leadership to really consider those things in earnest. We know we’re not going to win every battle but also know that the debate will be a fair debate. Hopefully the results will represent the will of the vast majority of the American people,” said Meadows.
The issue getting the most attention leading up to Donald Trump’s inauguration is the dismantling of the Obama health care law. Meadows says the House Freedom Caucus will soon advocate voting for replacement legislation at the same time they push for repeal.
“I believe we’ll start to coalesce around Sen. Rand Paul’s idea of having a replacement bill voted on the same day we vote on repeal. I think it’s important for the American people to understand that there are and have been replacement plans out there. It’s important to vote on that,” said Meadows, who says the votes could come as early as late February or early March.
“I think it will pass the House, may fail in the Senate and probably would fail in the Senate,” said Meadows.
That said, Meadows says a lot of Obamacare can be repealed through reconciliation instructions, but not all of it can be scrapped that way. But he says any tax provisions and the mandates can get the boot from a simple majority in the Senate.
Meadows also made headlines last month for offering the Trump transition team a book of 200 federal regulations that Trump could repeal upon taking office. He says the list is quickly approaching 300 regulations and the response from Trump’s team has been very encouraging.
“I’ve been led to believe many of those could be repealed on the very day of the inauguration after the parade. President Trump will then go in and sign those executive orders and treat that as day one of his new presidency,” said Meadows, who believes the American people will be grateful for a government looking for ways to make their lives easier.
Meadows suspects there may be some battles among Republicans over spending down the line, but probably not until the appropriations process plays out in autumn.
He is also pushing back against reports that House conservatives will be less demanding of a Republican president. Reports in December quoted House Freedom Caucus members as saying they might be willing to allow new spending that is only 50 percent paid for in other spending reductions. Meadows insists nothing has changed.
“We believe that any additional dollar of spending must be offset. We don’t have a taxing problem. We don’t even have a revenue problem. We have a spending problem, so if we want to find money for other areas, we need to reallocate that from existing revenue streams,” said Meadows.
“We cannot put the burden on our grandchildren or our children’s future. We’ve got to take the hard position now, the difficult choices now to make sure that we’re fiscally responsible. The Freedom Caucus is committed to making sure that we do that,” said Meadows.
Three Martini Lunch 12/13/16
Jim Geraghty of National Review and Greg Corombos of Radio America applaud Donald Trump’s selection of former Texas Gov. Rick Perry to be secretary of energy. They wince as Senate Majority Leader Mitch McConnell taps the brakes on the Trump tax plan and offers no ideas on how to reduce spending fight future deficits or replace Obamacare. And they discuss the Office of the Director of National Intelligence and the FBI disputing the CIA’s conclusion that Russia meddled in the 2016 campaign explicitly to help Trump win.