Republicans renew attempts to repeal Obamacare

A group of Republicans and Washington D.C. think tanks released a proposal Tuesday that aims to resurrect Obamacare repeal. The consistent chatter around the proposal has drawn ire from the White House and GOP leadership, as the midterms are just months away, and repeal efforts haven’t proved to be winning strategies.

The seven-page whitepaper titled “The Health Care Choices Proposal: Policy Recommendations to Congress” asks lawmakers to scrap the Affordable Care Act (ACA) and replace it with block grants. In other words, the bill would eliminate Obamacare subsidies and Medicaid expansion, and give states a fixed dollar amount so they can set up their own health system.

“But Obamacare is broken, can’t be fixed, and continues to do great harm. What’s needed is a fresh approach — one that gives Americans more choices of private, affordable coverage while making sure the most vulnerable are protected,” the proposal reads.

The “fresh approach” resembles the Graham-Cassidy bill, one of six failed GOP health bills from last summer that effectively deregulated the insurance market. “States decide how much insurers can charge people who are sick, required benefits, and cost-sharing,” Kaiser Family Foundation’s Larry Levitt said last September of the bill. Had it been enacted, millions of additional people would be uninsured, according to the Congressional Budget Office.

Last year’s Graham-Cassidy bill didn’t even make it to a floor vote, as there were too many Senate hard “no’s” against Obamacare repeal. It’s hard to see how this proposal is any different.

Should Obamacare repeal efforts return, the group of think tanks (including the Heritage Foundation, American Enterprise Institute, Galen Institute, and Manhattan Institute) led by former Republican Sen. Rick Santorum (PA), will likely give Democrats another health issue with which to campaign on.

The ACA is fairly popular, but it’s even more popular when it’s under attack. And health care ranks higher as a campaign issue for Democrats, mobilizing them to the polls. The Trump administration already handed Democrats a strong campaign weapon when they argued in court that protections for people with pre-existing conditions are unconstitutional.

“All these people out there not responsible for elected real-life senators don’t seem to realize there are consequences for failed votes,” one top Senate GOP aide recently told the Daily Beast. “We experienced them last summer. I don’t understand why we would want to have that again.”

When Republicans talk health care — particularly those who face tough midterm races — they usually bring up less contentious issues like opioid bills they’ve sponsored. And Obamacare repeal could be disastrous for people with substance use disorder, as Medicaid expansion helps cover a lot of people who need addiction treatment.

Graham-Cassidy 2.0

A major difference between the latest Republican proposal and that of last year’s is that the recent one does not significantly cut Medicaid. Under Graham-Cassidy 2.0, states have to offer “premium assistance” to people enrolled in Medicaid insurance. “Allowing people to cash out their Medicaid benefit in a world [with] no [pre-existing] protections likely raises federal costs significantly, as we would expect only the healthier Medicaid beneficiaries to take advantage,” tweeted Brookings Institution’s Loren Adler. In other words, the federal government will likely have to foot the bill for the sicklier Medicaid crowd.

Last year’s Graham-Cassidy bill was also criticized for using a formula that penalized states who expanded Medicaid. In this proposal, these states are still losers, tweeted Levitt.

As the think tanks try to encourage lawmakers to undo the Obama-era health law, people who purchase insurance on the individual market stand to lose. For states to receive block grant funding, they don’t have to require insurers to provide all 10 essential health benefits afforded under the ACA. And insurers can charge older people significantly more.

States and insurers have to follow some rules. For example, under the proposal, no health plan can cover abortion. While federal funding is already prohibited from directly funding the procedure, ACA health plans can cover abortion using other dollars; some 28 states provide some or all coverage for elective abortions.

Graham-Cassidy 2.0 may very well go nowhere, but it’s hardly the only way conservatives are trying to skirt health law. The Trump administration is expected to finalize a proposal Tuesday afternoon to free up association health plans. Small businesses and self-employed businesses can band together and buy insurance that do not comply with ACA rules. The plans are not, for example, required to cover maternity care or addiction treatment.


Reposted from Think Progress