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Time for Trump to Execute Promised Obamacare Repeal

November 10, 2016

Consumer Power Report #525

Welcome to the Consumer Power Report.

President-elect Donald Trump and congressional Republicans will soon hold power to pass and implement the most comprehensive U.S. health care policy reform in 100 years. How they use this power could depend on – to borrow a phrase from former President Bill Clinton – what the meaning of the term “campaign promise” is.

“Completely repeal Obamacare,” reads the first line of Trump’s seven-point general outline for replacing the Affordable Care Act (ACA), released before the first presidential debate.

Since then, as before, the Trump campaign largely avoided committing to specifics, a strategy Trump’s team must soon abandon in order to implement, with Congress’s approval, any of the campaign’s proposed free-market reforms, which are agreeable to most Republicans:

 

1. “Completely repeal Obamacare.” (Note to reader: I’ve omitted the rest of #1. You’ll soon see why.)
2. Allow insurers to offer plans across state lines.
3. Make health insurance premiums tax deductible for individuals, as they are for employers.
4. Let individuals use Health Savings Accounts (HSAs), for their own expenses and a family member’s.
5. Require price transparency from health care providers so patients can shop around.
6. “Block-grant Medicaid to the states,” which are best equipped to address their people’s needs and “would have incentives” to stop fraud.
7. Remove market-entry barriers for drug developers, including foreign-based competitors.

 

Some of these points, taken from the campaign’s ”Healthcare Reform” paper, appear simple enough so as not to require specifics. “Completely repeal Obamacare,” for instance, is a clear enough directive, even if its execution will be complicated by some parts of ACA that could prove difficult to undo.

Whether Trump succeeds in fulfilling his black-and-white campaign promises hinges on his resolve – which, intentionally or not, his campaign literature colors gray.

This is because following “Completely repeal Obamacare,” the Trump campaign paper states, “Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.”

Insisting Congress eliminate the individual mandate is absolutely the correct position. But singling out the individual mandate is a bizarrely narrow way to clarify, justify, or elaborate on the meaning of “Completely repeal Obamacare.”

Terrors stemming from ACA extend beyond the individual mandate. They include the employer mandate, requiring employers to offer health benefits if they employ 50 or more employees working 30-plus hours a week. They include the contraception mandate, requiring employers to violate their consciences by abetting the federal government and health insurers in providing employees contraceptives. (The U.S. Supreme Court relieved religious employers of complying with this mandate, at least temporarily, by punting reconsideration of the constitutional question to lower courts on May 16.)

ACA terrors include illegal payments from the Centers for Medicare and Medicaid Services to health insurers, payments legally destined for the U.S. Treasury. Most recently, they include CMS Acting Administrator Andy Slavitt’s plan to give insurers a $2 billion to $15 billion bailout for their bad investment in Obamacare, courtesy of the Judgment Fund, a Department of Justice fund reserved for lawsuit settlements. Slavitt has openly invited insurers to pursue these settlements at taxpayers’ expense, in express contradiction of his claim the federal government is fulfilling its duty to defend taxpayers against such lawsuits.

One wonders if the Trump campaign’s elaboration of his plan’s first point, “Completely repeal Obamacare,” was an attempt to qualify what “repeal” means – or could be made to mean by a Trump White House retro-fitting this campaign promise to justify repealing only the individual mandate, not other parts of Obamacare. After all, Trump himself has uttered statements apparently contradicting his market-based proposals.

Alexander Hamilton (of no known relation to the author) similarly warned excessive so-called clarification could undermine the very meaning of the point supposedly clarified. In 1788, Hamilton argued against adding the Bill of Rights to the U.S. Constitution, writing in The Federalist No. 84 that these amendments would be “unnecessary” and “would even be dangerous.”

“They would contain various exceptions to powers not granted; and, on this very account, would afford a colorable pretext to claim more than were granted,” Hamilton wrote. “For why declare that things shall not be done which there is no power to do?”

Indeed. Why specify one sliver of ACA shall be repealed if the plan is to “Completely repeal Obamacare”?

An indefinite but undoubtedly huge swath of the 59.7 million people (and counting) who voted for Trump did so trusting he would work with Congress to dismantle ACA. Republicans have already introduced a handful of specific, number-crunching pieces of legislation fleshing out Trump’s campaign promises, some better than others.

Here’s hoping the executive branch executes one of them.

-- Michael T. Hamilton (mhamilton@heartland.org) is a Heartland Institute research fellow and managing editor of Health Care News, author of the weekly Consumer Power Report, and host of the Health Care News Podcast.


IN THIS ISSUE:


TRUMP UPSET WILL FORCE HEALTH CARE LEADERS TO RETHINK THE FUTURE

Republican Donald Trump’s shocking victory Tuesday will force a major shift in the healthcare industry’s thinking about its future. …

Addressing supporters just before 3 a.m. ET, Trump struck a conciliatory tone and did not specifically mention the ACA. “It is time for us to come together as one united people,” he said. “It’s time.”

But the assumption of Republican control over both the White House and Congress most likely means an end to the expansion of Medicaid to the 19 states that have not yet implemented it, and puts the expansion in the other 31 states in serious jeopardy.

Still there are divisions even among conservatives over issues such as Medicare restructuring and how to help Americans afford health insurance. And Senate Democrats almost certainly would try to use their filibuster power to block major ACA changes. …

“When we win on Nov. 8 and elect a Republican Congress, we will be able to immediately repeal and replace Obamacare. We have to do it,” Trump said.

“I will ask Congress to convene a special session so we can repeal and replace,” he added. “And it will be such an honor for me, for you and for everybody in this country because Obamacare has to be replaced. And we will do it, and we will do it very, very quickly. It is a catastrophe.”

Some conservative policy analysts believe that under a Republican-controlled government, the ACA probably would be shrunk rather than abolished and would receive a new name. It’s widely expected that Trump will hand off the health policy portfolio to House Speaker Paul Ryan, whose House leadership white paper is seen by conservative wonks as the blueprint for a Republican administration’s policy.

Some think the political backlash from suddenly ending ACA coverage for an estimated 20 million Americans will prompt Trump and congressional Republicans to proceed cautiously. …

Given their druthers, Trump and congressional Republicans would push to end the individual and employer mandates, eliminate ACA insurance reforms such as minimum essential benefit packages, pare back and restructure the premium subsidies, and junk the CMS Innovation Center and the Medicare Independent Payment Advisory Board….

Experts say those measures would largely unravel the ACA system and could lead to millions of people losing coverage.

It’s not clear whether or how a Trump administration would provide subsidies to help people buy or keep coverage. The House Republican leaders’ plan proposed refundable tax credits for individuals without access to employer-based or public coverage. But the Trump campaign’s seven-point healthcare proposal and the GOP health policy agenda don’t mention any subsidy mechanism. Another issue is that if they moved to repeal the ACA and its hundreds of billions in revenue, Republicans would have no way to fund subsidies for the uninsured, noted John Goodman, a veteran Republican health policy expert.

House GOP leaders have proposed taxing employer health benefits to provide revenue for subsidies and help control overall healthcare spending. But it’s not clear whether Trump would embrace such a widely unpopular measure. …

The House Republican leadership plan, which calls for repealing the ACA and its Medicaid expansion, would let states roll back their coverage extensions to “able-bodied” adults. At the same time, conservative experts argue that giving states more flexibility under the block-grant approach, such as letting them set work requirements and trim benefits, would enable them to cover this population more cost-effectively. …

SOURCE: Harris Meyer, Modern Healthcare


SINGLE-PAYER COLORADOCARE MEASURE AMENDMENT 69 DEFEATED SOUNDLY

Amendment 69, the ballot measure known as ColoradoCare that would have created a universal health care system in Colorado, was soundly defeated Tuesday night.

At 8:30 p.m., with nearly 1.8 million votes counted across the state, the amendment was trailing 79.6 percent to 20.4 percent, according to preliminary state figures. Updated vote totals at 7 a.m., with 86 percent of the vote counted, the measure continued trailing at roughly the same percentage or 1,833,879 to 467,424. Throughout the campaign, the measure had polled better with Democrats than Republicans. But even in left-leaning Denver, the amendment was losing 2-to-1, according to early returns. …

But supporters also acknowledged it was unlikely the measure would recover and vowed they would try again another year. …

Opponents declared victory.

“We’re grateful to the people of Colorado for carefully considering Amendment 69 and voting overwhelmingly against a measure that was clearly risky, untested, and fiscally irresponsible,” Kelly Brough, president and CEO of the Denver Metro Chamber of Commerce and chair of opposition group Coloradans for Coloradans, said in a statement.

Amendment 69 would have eliminated most private health insurance in the state and replace it with a taxpayer-funded cooperative known as ColoradoCare, which would have provided coverage to every single Colorado resident. It would have been paid for, largely, through a 10 percent payroll tax – workers at businesses would have been responsible for a third of the tax, while their employers would have picked up the rest; the self-employed would have paid the full 10 percent. The cooperative’s budget, at about $36 billion a year when fully implemented, would have dwarfed the state government’s budget. …

SOURCE: John Ingold, The Denver Post


AFTER ELECTION, TEXANS PREPARE FOR POSSIBLE HEALTH CARE CHANGES

Elated congressional Republicans pledged swift action Wednesday on President-elect Donald Trump’s agenda as they heralded an extraordinary new era of unified GOP control in Washington.

“He just earned a mandate,” House Speaker Paul Ryan of Wisconsin declared of Trump. “We are going to hit the ground running.” …

First up would be repealing President Barack Obama’s health care law, something Republicans have already shown they can get through Congress with just a narrow Senate majority. What they haven’t done is unite around a plan for ensuring that the 20 million who achieved health care coverage under the landmark law don’t lose it.

Non-profits continued signing up people for insurance coverage through Obamacare Wednesday in central Texas.

“I’m actually having surgery a week from today,” said Jill Ventimiglia, owner of Just Jill Beauty & Wellness, a small business. “And I wonder if I waited until next year, if that would even be a possibility.”

Ventimiglia says before the health care law she could not get her own insurance coverage because of a preexisting condition. KXAN also covers the experience of Ventimiglia’s parents a few years ago. After Obamacare passed, their insurance company canceled the plan they liked and they said their offers in the marketplace were more than double the cost.

Still, any changes will likely not be immediate.

“There are subsidies that are already committed for 2017,” said Elizabeth Colvin, program director with the non-profit Foundation Communities. “I think that we will see those issues already committed. I think we will see those issues in 2018, but people have an opportunity to sign up now through Jan. 31.” …

Some of Trump’s goals could be harder to achieve. A wall on the southern border is estimated to cost $10 billion to $20 billion, money that Congress may be unlikely to provide given that cooperation from Democrats would be necessary.

Indeed the Senate Democratic minority stood as the only legislative barrier to Trump’s goals, since 60 votes are required for most consequential moves in the Senate.

SOURCE: Erica Werner, Kevin Schwaller, Associated Press, KXAN


HEALTH CARE BALLOT MEASURES THAT PASSED: STATE BY STATE

Americans took to the polls yesterday to officially declare Republican nominee Donald Trump the 45th president of the U.S. Equally important was the passage of several key healthcare ballots in states across the country. But a number of other healthcare related issues also appeared on the ballots.

Here are issues that appeared on 2016 election ballots in 10 states and passed, according to Ballotpedia.org. …

Arkansas:

  • Issue 6, which legalized medical marijuana,.

California:

  • Proposition 52, which consisted of numerous changes to the hospital fee program.
  • Proposition 56, which increased the tax on cigarettes by $2 per pack.
  • Proposition 64, which legalized marijuana and hemp.

Florida:

  • Amendment 2, which legalized physician-prescribed marijuana.

Massachusetts:

  • Question 4, which legalized recreational marijuana for individuals at least 21 years-old.

Montana:

  • I-182, which legalized the use of medical marijuana.

Nevada:

  • Question 2, which called for the legalization of marijuana.
  • Question 4, which called for a sales tax exemption on the sale and purchase of medical equipment.

North Dakota:

  • Measure 5, which allows individuals to use medical marijuana.

Ohio:

  • Issue 64 on the Cuyahoga County ballot, which closed Lakewood Hospital.

SOURCE: Alyssa Rege, Becker’s Hospital Review

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Health Care
Author
Michael Hamilton writes and edits for the liberty-minded clients of Good Comma Editing, LLC, a freelance writing and editing company.
media@heartland.org @MikeFreeMarket

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