Once again, it appears healthcare reform has died in Congress, and now that time is running out for Republicans to take advantage of the Senate’s budget reconciliation rules, it looks as though there’s virtually no chance healthcare reform will be passed in the near future.
Adding insult to injury was a Sen. Susan Collins, R-Maine, statement announcing her rejection of the Graham-Cassidy healthcare proposal, in which she complained the legislation would have cut too much of the federal government’s funding of Medicaid and that the bill would “open the door for states to weaken protections for people with pre-existing conditions … Some states could allow higher premiums [and] … could also limit specific categories of benefits for Affordable Care Act policies, such as eliminating coverage for mental health or substance abuse treatment.”
Let’s get this straight: Collins says she opposes the Graham-Cassidy proposal because it would reduce federal involvement in healthcare and allow states to choose what kind of healthcare policies would work best for their own people. What a stunning statement from a Republican senator and alleged supporter of free-market, pro-liberty reforms!
If the Senate Republican leadership can’t even get all its senators to agree that Medicaid has been a massive failure and states should have more rights when it comes to healthcare, there is no hope of Washington resolving this problem under the current composition of Congress. Fortunately, there’s plenty the Trump administration and states can do on their own to bring the cost of health insurance down and prevent the current system from completely collapsing.
One of the most interesting ideas was recently advanced by Sen. Rand Paul, R-Ky. He said during an interview with MSNBC on Wednesday the Trump administration could alter existing rules to allow people to buy health insurance across state lines, thereby dramatically increasing competition and lowering prices. The Trump administration is already reportedly preparing such an executive order.
Under the Employee Retirement Income Security Act, corporations are permitted to buy insurance from providers across state lines so long as their workers reside in multiple states. Paul believes ERISA could be reinterpreted so that individuals who are members of associations could take advantage ERISA, and he says the change wouldn’t require a new law from Congress.
“I believe that President Trump can legalize on his own the ability of individuals to join a group or a health association across state lines and buy insurance,” Paul said.
“If these individuals can join large groups across state lines, I think they’ll get protection, less expensive insurance, and it’ll be able to solve a lot of the problems we have in the individual market,” Paul added. “I think President Trump is going to do this on his own.”
States have plenty of options as well.
Section 1115 of the Social Security Act allows states, with the permission of the Department of Health and Human Services, to make reforms to their Medicaid and Children’s Health Insurance Program systems. States could apply to change their programs so that able-bodied adults are required to seek work or attend school to continue receiving benefits. States could also change their rules so that able-bodied Medicaid enrollees must contribute a small amount toward their coverage. Both these strategies have proven to be successful in the past in reducing welfare rolls because they discourage dependency.
States can also apply for Section 1332 waivers, which would allow them to make important changes to their health insurance markets, thereby limiting the damage of Obamacare. For instance, states could apply for a waiver that would allow insurance companies to sell plans on the Obamacare exchange that have fewer essential health benefits included, making policies significantly cheaper. States could also apply to end the employer mandate, which forces employers with 50 or more full-time employees to provide insurance or else pay a penalty—a rule that has stifled growth for many small businesses and resulted in employees working fewer hours.
These reform opportunities aren’t perfect. Executive action is limited to existing law, and waivers cannot be used to fix many of the problems currently facing the healthcare system. Further, waivers only last for five years, which means if Trump loses his re-election bid in 2020, a Democratic president could come into office and reverse these policies by denying waiver-renewal requests. Despite these challenges, these reforms still have incredible potential and could be passed relatively quickly.
Congress may have failed voters, but the Trump administration and the states have the power to make changes on their own. They must not waste this important opportunity!
Justin Haskins (@JustinTHaskins) is a contributor to the Washington Examiner’s Beltway Confidential blog. He is an executive editor at The Heartland Institute.
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