By: Federalist Gwen
Last week, the Speaker of the House, Paul Ryan, introduced the long awaited reform of the Affordable Care Act, also known as Obamacare. Republicans, including Donald Trump, campaigned on completing repealing this federal government takeover of health care. The replacement plan was promised to introduce free market reforms, lower costs, and to roll back regulations and taxes. The following article is a first glance at the proposed bill. As noted in the first section, it is difficult to wade through as it is mostly revisions to other bills. In 2015, the House and Senate passed a complete repeal of the ACA. President Obama vetoed it. One wonders why, now with a larger majority and the Presidency, that bill was not reintroduced as a logical first step.
Read the Bill
The text of the American Healthcare Act is confusing. The bill is a series of deletions, and replacements to other legislation, primarily the Affordable Care Act, and it is frankly, unreadable. If the House Republicans really want us to read and understand the bill, a redlined ACA should be made available to the public.
Free Market Reforms versus Government Interference
The bill is anti-free market. The House proposal retains the provisions of allowing adult children up to age 26 to remain on their parents’ coverage, and it disallows denial of insurance for preexisting conditions. These provisions, although popular, are, from a Federalist point of view, extreme over reach. Insurance regulation belongs at the state level. Furthermore, it is unreasonable to force insurers to take on unreasonable risk. In fact, it is certain loss! Coupled with the removal of the individual and employer mandates, it is a certainty that some people will wait until they are sick to purchase health insurance. The promise of allowing individuals to purchase insurance across state lines was also not kept by the authors of this bill.
Don’t fix what isn’t broken
The coverage of preexisting illnesses and conditions was already dealt with by the Health Insurance Portability and Accountability Act of 1996. HIPAA mandated coverage of all illness and conditions providing the buyer had maintained coverage. If they had not maintained coverage, pre-existing condition exclusion was limited to 12 months. Again, Federalists question the federal government’s role in regulating health insurance, but these provisions encouraged continuity of coverage yet provided a mechanism to eventually obtain coverage.
Expanding Federal Entitlements
The growth of federal entitlements must stop. In Federalist #45, James Madison wrote: “The powers delegated by this proposed Constitution to the Federal government are few and defined.” One of the more troubling aspects of the Affordable Care Act was the expansion of Medicaid. Medicaid was intended for states to provide health care for societies most vulnerable populations: Poor pregnant women, poor children, and disabled people. The Federal government provides subsidies to the States to do this. Although, we certainly support the concept that we as a society must protect and provide for these most vulnerable persons, we question the Constitutionality and wisdom of the Federal government taking this role. That being said, the ACA further expanded the federal government’s reach into the States. The Federal government provided subsidies of 90-100% for states to enroll able-bodied adults into Medicaid while continuing to support poor children, mothers, and the disabled at 50-75%. As a result, states were incentivized to enroll able-bodied adults over the most vulnerable members of our society. The current House proposal actually expands this entitlement by expanding the subsidies and failing to address the inequality noted above. Before this proposed bill was unveiled, Medicaid was already projected to cost more than the entire defense budget. This is unsustainable. In 1788, in a speech to the New York state ratifying committee Alexander Hamilton said, “The State governments possess inherent advantages, which will ever give them an influence and ascendancy over the National Government, and will forever preclude the possibility of federal encroachments. That their liberties, indeed, can be subverted by the federal head, is repugnant to every rule of political calculation.” He was most certainly correct.