"There must be some kind of way outta here" said the joker to the thief in Bob Dylan's song, adding, "There's too much confusion / I can't get no relief." Dylan could hardly have chosen better words if he'd been writing about Obamacare and Republican efforts to repeal the confusing web of regulations, taxes, and mandates.
The Trump administration, thankfully, is poised to grant some relief through executive action later this week. The president's action should give health insurance customers at least a few ways outta the Obamacare confusion by allowing them sometimes to buy insurance across state lines, by expanding health savings accounts, and by quadrupling the upper limit on short-term health insurance plans from three months to nearly a year.
Best of all, Trump will use "association health plans" to sell insurance across state lines. This unconfirmed but promising modification would allow people or small groups to join association plans, which carry the privileges and benefits of an employer-sponsored plan. Those benefits include group pricing, which is cheaper, and exemption from most of Obamacare's costly mandates. These plans could be sold by providers in one state to buyers in another state, meaning they'd generally be less regulated than today's plans.
Trump's critics and the Obamacare lobby complain that these plans won't always cover every illness or infirmity known to man. But just as a house on high ground in the desert doesn't need flood insurance, health plans don't need to be identical for everyone. Sixty-year-olds shouldn't have to pay for maternity care insurance.
The flight of young and healthy people from Obamacare exchanges harms those exchanges. But this objection rests on Obamacare's premise that people should be forced to buy plans more expensive than the one they want.
Young people generally have less money and fewer assets than older people, whose healthcare they are required by Obamacare to subsidize. By pushing millennials onto exchanges, Obamacare turned young, healthy people into cash cows for everyone else.
Rather than this transfer of wealth from poorer to wealthier people via insurers, a real safety net for high-risk patients would allow market forces to work in the private sector. Or, better, Congress should take action to allow high-risk insurance pools.
Any new flexibility is progress. But Trump and Republicans should remember what conservatives told President Barack Obama for years: Live by the "power of the pen," die by the power of the pen.
The next president from the Democratic Party could undo Trump's executive order just as easily as Trump signs this one. Before that, the final rules will surely face legal challenges, just as Obamacare faced three that went to the Supreme Court. Lastly, voters aren't stupid. They know an executive order is no substitute for comprehensive reform and that most of Obamacare will stay in place. When they vote in 2018 and 2020, if Obamacare hasn't been repealed, insurers will still offer limited options and rising premiums.
So yes, Trump should sign this executive order, and it will be celebrated not just by the administration but by all those who suffer under Obamacare. But Republicans in Congress must pass reform legislation or get their just deserts at the ballot box.
As Bob Dylan wrote, "The hour is getting late."