Even with Republican control of both chambers of Congress and the White House, the effort to repeal and replace Obamacare has proceeded in fits and starts. However, Obamacare critics got a big boost from President Trump in his address to Congress Tuesday night and should now be very optimistic about the path forward, a path that hopefully includes an Obamacare repeal and replace plan for all Republicans.
Trump’s speech provided support for core components of the House Republican plan, including tax credits, expanded Health Savings Accounts, and allowing the cross-state purchase of health insurance. This wasn’t shocking, as the House plan is a close cousin of the Empowering Patients First Act, a bill authored by former congressman and current Secretary of Health and Human Services Tom Price. Borrowing heavily from the Price plan was a wise move, both because of its strong policy merits and because it had a great deal of support from conservatives.
Indeed, the 84 cosponsors of his bill are a veritable “who’s who” of the conservative wing of the House Republican Conference. The list includes former Rep. Mick Mulvaney (now Trump’s top budget official); Rep. Mark Meadows (the current Freedom Caucus chairman); as well as several other thought-leaders from the Freedom Caucus like Reps. Andy Harris, R-Md.; Scott DesJarlais, R-Tenn.; Trent Franks, R-Ariz.; Ted Yoho, R-Fla.; and Jeff Duncan, R-S.C. (Harris and DesJarlais are both doctors).
Having all of these influential lawmakers united behind Price’s bill will help provide political momentum for its core policy provisions, most of which were included in the House GOP plan.
One of the most important provisions is the creation of a new tax credit that will be available to all individuals and families for the purchase of health insurance. Here, the centerpiece of the GOP plan very closely mirrors the Price bill. Both tax credit structures would be age-adjusted to reflect the higher costs of healthcare plans for older Americans. The House plan and the Price bill both make the credits advanceable and refundable.
This is essential for providing real assistance to Americans on the lower rungs of the economic ladder, many of whom do not have the resources to purchase insurance without immediate assistance. While some conservatives have expressed concerns about this provision, it’s tremendously significant that a large portion of the Freedom Caucus, including its current chairman, have implicitly endorsed it by cosponsoring the Price legislation.
Also critical to the plan is a major expansion of health savings accounts. Here again, the GOP and Price plans are similar. Both would significantly increase the contribution limits and provide far greater flexibility in terms of eligible expenses and uses. Supercharging HSAs is an absolute necessity for any conservative, credible Obamacare replacement.
Additionally, Freedom Caucus members should be pleased that the House plan goes much further than the Price bill on restructuring entitlements. It would empower states to innovate by allocating Medicaid funds on a per capita basis. Though Trump has expressed some reluctance about reforming entitlement programs, doing so is a justifiable policy imperative for limited government advocates.
Obamacare has been an abject failure. Many GOP officials are in office today because their constituents are passionately opposed to the law and want it repealed and replaced. Now, Republican policymakers have a chance to do just that. Getting the policy and politics correct won’t be easy, but GOP leadership is right to build upon a bill authored by Trump’s top health care official.
Further, the strong support this bill received from the Freedom Caucus and other conservative lawmakers suggests that this framework might provide the path forward for the effort to repeal and replace Obamacare. It would be an absolute travesty if this effort was derailed by Obamacare’s most passionate opponents. That would mean few constructive, politically viable alternatives to move forward, ironically undermining the very goal of repeal and replace they claim to seek.
Brandon Arnold (@BrandonNTU) is the executive vice president of the National Taxpayers Union.
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