On Politics: Setting the stage to delegate health care
January 26, 2018
As this is being written, the United States has no budget and no congressional continuing resolution to spend; "non-essential" government personnel and services will not be funded, even "essential" services (military, Social Security, etc.) are threatened if this drags on too long, Democrats are pointing fingers at Republicans, Republicans are pointing fingers at Democrats, all in all: situation normal.
So, while political party leaders are publicly condemning each other as they privately try to make deals let's take a look at the Affordable Care Act ("ACA"), commonly known as Obamacare.
In January 2009, Barack Obama was inaugurated president of the United States and led a Democratic majority in the House and super-majority of 60 seats in the Senate. This latter was important because when a minority party has 41 or more Senate seats it can bring work to a halt under somewhat arcane rules that only apply to that body.
Speaker Nancy Pelosi had cobbled her House majority to approve a complicated "universal" health care bill while Majority Leader Harry Reid had crafted a very different Senate bill. The next step would have been to send both bills to a joint conference committee for reconcilement where the rough edges and inconsistencies would be smoothed over.
Both houses would then approve the reconciled measure. Suddenly Sen. Ted Kennedy (D–Mass.) died and Massachusetts voters elected Republican Scott Brown to succeed him. That gave the GOP a 41st Senate seat, which meant there weren't the votes in that chamber to approve the reconciled bill.
So Reid and Pelosi just had the House adopt the Senate bill, which Obama signed. That's how this imperfect law came into being.
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Fast forward to 2016. All 17 GOP presidential candidates were preaching "repeal and replace Obamacare." As we know Donald Trump won the primaries and the general election, plus a majority in the House and the Senate and so the task of obliterating Obamacare began. The House was quick about it and sent their bill to the Senate.
There the process unraveled owing to several GOP prima donna senators who couldn't agree with the majority. So "repeal and replace" died, or did it?
Because of the way Democrats and Obama shoehorned the 2,700-page ACA into law, there were a number of unfortunate provisions that might have been corrected in the reconciliation process. The law gives the secretary of Health and Human Services ("HHS") sweeping control over implementation and oversight of the ACA.
Over 1,400 places in the law provide "The Secretary shall." So the Trump administration has quietly taken advantage of that latitude to slowly dissemble Obamacare. Insurance company subsidies were cut or eliminated, enrollment periods shortened, funds for publicity cut; finally, the GOP Tax Reform Bill signed last month eliminated the ACA's individual mandate — the provision requiring every citizen to obtain and maintain health insurance that complies with the law.
Without the mandate young, healthy individuals may opt out of coverage altogether leaving insurers to underwrite pools of older, sicker people, resulting in higher and higher premiums.
So, as Obamacare falters what next? Roger Stark, a physician with the Washington Policy Center, has dissected the ACA. Writing as a visiting scholar to the Nevada Policy Research Institute, Dr. Stark proposes that individual states apply to provide their own health insurance programs in lieu of Obamacare.
Requests are decided by the HHS Secretary; 22 states have applied or considered this action. Also states, such as Nevada who opted to expand Medicaid coverage, can apply to change the rules on how the program is administered including imposition of a work requirement on Medicaid beneficiaries.
So, the stage is set to delegate large chunks of health care to individual states; just like the founding dads intended when they formed a republic.
Jim Clark is president of Republican Advocates. He has served on the Nevada and Washoe County GOP Central Committees. He can be reached at firstname.lastname@example.org.