Not let­ting the Oba­macare cri­sis go to waste

The pro­gram dies quickly with­out in­surance com­pany sub­si­dies

The Washington Times Daily - - OPINION - By Twila Brase Twila Brase, a reg­is­tered nurse, is pres­i­dent and co-founder of Cit­i­zens’ Coun­cil for Health Free­dom.

Repub­li­cans should take a les­son from Democrats. Dur­ing Pres­i­dent Obama’s bat­tle to en­act Oba­macare, his chief of staff, Rahm Emanuel, fa­mously said, “You never want a se­ri­ous cri­sis to go to waste. What I mean by that is an op­por­tu­nity to do things you could not do be­fore.”

I agree. Eight years later, Amer­i­cans are in a se­ri­ous cri­sis be­cause of Oba­macare. And now there’s a huge op­por­tu­nity to deep-six the law. Repub­li­cans should not let it go to waste.

It’s time to pivot. The GOP lead­er­ship’s Amer­i­can Health Care Act (AHCA) failed. The Oba­macare re­place­ment bill was op­posed by con­ser­va­tives and mod­er­ates alike. Rep. Justin Amash, Michi­gan Repub­li­can, called the bill “Oba­macare 2.0.” The Repub­li­can House Free­dom Cau­cus re­fused to sup­port it. And the longer mod­er­ate Repub­li­cans looked at its de­tails, the less they liked it. Af­ter at­tempt­ing to pass AHCA on Oba­macare’s sev­enth an­niver­sary, the bill died.

So, why waste time try­ing to res­ur­rect AHCA or pass an­other Oba­macare re­place­ment bill? Amer­i­cans want Oba­macare re­pealed.

Repub­li­cans should be­gin by fol­low­ing through with Pres­i­dent Trump’s threat. End the unau­tho­rized Oba­macare cost-shar­ing re­duc­tion (CSR) sub­sidy pay­ments, es­ti­mated to be $7 bil­lion in 2016. This one ac­tion could sink much of Oba­macare. Mr. Trump re­cently told The Wall Street Jour­nal that “Oba­macare is dead next month if it doesn’t get that money.”

Congress should make it so. Cost-shar­ing re­duc­tion sub­si­dies were au­tho­rized by the Af­ford­able Care Act (ACA) to re­duce the cost of de­ductibles and co­pay­ments for low­er­in­come Amer­i­cans, but the Demo­crat-led Congress never ap­pro­pri­ated fund­ing for pay­ments. The Obama ad­min­is­tra­tion ig­nored this in­con­ve­nient fact and gave bil­lions of dol­lars to health in­sur­ers in CSR pay­ments. This al­lowed millions of Amer­i­cans to sign up for Oba­macare cov­er­age they could only af­ford be­cause the govern­ment sub­si­dized their pre­mi­ums through tax­payer-funded Ad­vance Pre­mium Tax Cred­its, as well as their de­ductibles and co­pay­ments through tax­payer-funded CSR pay­ments.

In 2014, the Repub­li­can-led Congress sued to block the Oba­macare ad­min­is­tra­tion from mak­ing these unau­tho­rized pay­ments. U.S. District Judge Rose­mary Collyer ruled in fa­vor of Congress, but let the pay­ments con­tinue, pend­ing the out­come of an ap­peal by the ad­min­is­tra­tion. The 2016 pres­i­den­tial elec­tion changed ev­ery­thing. Pres­i­dent Trump now has the power to sim­ply drop the ad­min­is­tra­tion’s ap­peal and stop the pay­ments.

With­out pay­ments, the game is up. The sub­sidy-rid­den veil sur­round­ing the true cost of Oba­macare will be ripped to shreds. And health plan pre­mi­ums, loaded with ACA man­dates and reg­u­la­tory re­quire­ments, will sky­rocket to their ac­tual cost.

The fall­out will be im­me­di­ate. Amer­i­cans who could never af­ford Oba­macarepriced pre­mi­ums will refuse to buy cov­er­age. En­roll­ment will plum­met. The healthy will forgo cov­er­age. The sick will pay what­ever it takes to keep cov­er­age. Health plans will lose their tax­payer­funded fi­nan­cial cush­ion and exit the Oba­macare ex­changes in droves. And the Health­ ex­change, funded by a sur­charge on monthly pre­mi­ums, will im­plode.

This is where cri­sis and op­por­tu­nity come to­gether.

The Af­ford­able Care Act dis­man­tled the in­surance mar­kets that ex­isted in 50 states and re­placed them with one “fed­eral mar­ket­place” (Health­ and a few in­ter­con­nected state ex­changes. The ACA also fa­vored, and thus em­pow­ered, large man­aged care cor­po­ra­tions. Sec­tion 1302(e) of the law pro­hibits the sale of cat­a­strophic cov­er­age — ma­jor med­i­cal in­dem­nity in­surance poli­cies — to any­one over the age of 29. As a re­sult, millions lost these af­ford­able poli­cies and were forced to buy lim­ited op­tions of un­af­ford­able cov­er­age of­fered through the Oba­macare ex­changes.

It’s time to right the Oba­macare wrong. The real mar­ket­place ex­ists out­side of govern­ment-con­trolled ex­changes. Af­ford­able in­surance ex­ists out­side of man­aged care cor­po­ra­tions. True in­surance ex­ists out­side of Oba­macare cov­er­age.

Mr. Trump should drop the ad­min­is­tra­tion’s ap­peal against the Repub­li­can law­suit and stop CSR pay­ments. Repub­li­cans in Congress should refuse to fund CSR sub­si­dies. The pend­ing Con­tin­u­ing Res­o­lu­tion, which ap­pro­pri­ates money to keep the fed­eral govern­ment funded, should not in­clude sub­si­dies. And Repub­li­cans in ev­ery state­house around Amer­ica should re­assert their right to di­rect health care within their borders and en­act laws to make it so.

The time, and op­por­tu­nity, to end Oba­macare is now.


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