How Cruz Can Stomp Sanders in Tonight’s Obamacare Debate

Published February 7, 2017

Sen. Ted Cruz (R-TX) will dominate Sen. Bernie Sanders (I-VT) in tonight’s CNN debate over the merits and demerits of Obamacare, as long as he does three simple things. Cruz should take a populist play from Trump’s playbook, put the so-called uninsurable population at ease, and myth-bust Medicaid expansion, the failed messiah of the Affordable Care Act (ACA).

CNN’s many faults notwithstanding, tonight’s showdown is a brilliantly conceived contest between runners-up in the presidential primary elections that cemented then-future President Donald Trump and former Secretary of State Hillary Clinton as their parties’ respective nominees.

Unlike a vice-presidential debate, tonight’s confrontation is not a duel between lieutenants. Cruz is not Trump’s man. Sanders is not Clinton’s. Neither senator is strapped with the obligatory role vice presidential candidates have of balancing out the ticket by apologizing, reinterpreting, rephrasing, and papering over the campaign blemishes in his respective presidential candidate.

On the contrary, each senator has fairly bludgeoned his party’s victor at one time or other. Unlike most of his fellow failed presidential candidates, each stated his intentions at least once not to endorse the upstart Trump or crony Clinton. The senators even stuck to their guns a short while before deciding this was fruitless to their causes.

And it is the senators’ causes that distinguish them from Trump and Clinton, as well as from Vice President Mike Pence and former vice presidential candidate Sen. Tim Kaine (D-VA). Cruz and Sanders were the ideological puritans among the 2016 presidential contenders. If ideology were theology, it would be fair to say Cruz lost to the dubious and untested new convert Trump, and Sanders lost to the elitist apostate Clinton (whose cash-infused cronyism and scandals undermine the progressive religion).

Tonight Cruz and Sanders will emerge from their righteous corners, bump fists, and call down fire from heaven (or up from hell, depending on your persuasion) to consume the offering Obama hath placed on the altar, the same offering Trump has failed so far to remove: Obamacare.

Winning is important because a Cruz victory could give Trump and Congress the courage they need – and which they claimed to possess during their campaigns – to repeal ACA within weeks or months instead of years.

Here’s how Cruz can win:

Play to Populism. There never was a more perfect opportunity for Cruz to steal Trump’s populist thunder than tonight. For the first time, people can have their cake and eat it too. Trump’s base of disenfranchised Muricans can and should rally around Cruz, because unlike in 2016, they do not have to choose between them.

Cruz should call to Trump’s base with consumer-driven health care solutions. The population that voted for Trump are health care consumers. So are the people who voted against Trump. Consumers like options and the freedom to choose for themselves which products and services offer the best value. Cruz (and Trump) should buy their love – not with money but with choices over health care that Obama took away.

There is more than one way to throw bread to the crowds at the circuses. Freedom to choose is more precious than federal subsidies. Cruz should hammer the point Trump and Congress appear to be missing: Repealing ACA without a replacement plan ready would launch waves of state-based, free-market health care reforms resulting in greater health care access, quality, and value.

State lawmakers are prepared to enact these reforms, in part because The Heartland Institute, with its more than 1 million state legislative contacts per year, is constantly writing about them, most recently in the two-pager “”>–commentary-10-health-care-reform-options-for-states”>10 Health Care Reform Options for States,” published February 1.

Assure the Uninsurable. Given Trump’s cavalier promise-making and Republican lawmakers’ fear of political suicide, there’s no way Trump and Congress will repeal Obamacare without a plan in the works to help the so-called uninsurable population. These uninsurables are potent ammunition for Sanders and the Democrats, who launch them like human cannonballs at Republicans whose policies would improve their quality of life.

So Cruz should concede early and often that government is going to help uninsurables pay for health care. Atlas will not shrug all the way. The federal government or state government or (most likely) a combination of each will pay.

How they pay, however, will make all the difference. Obama tried serving uninsurables by distorting the entire insurance market with onerous, expensive mandates on individuals, employers, and insurance companies. We’re living with the result.

Trump can help uninsurables by breaking them away from insurables. A market of insurables-only would thrive when freed from ACA mandates and enriched by state-led, consumer-driven health care reforms. Meanwhile, newly formed pools of uninsurables could receive taxpayer assistance less circuitously and far more efficiently than by turning an entire industry inside out.

Myth-bust Medicaid Expansion. This is a three-for-one. First, the claim 20 million people gained insurance under Obamacare a myth. The real number is closer to 16.5 million, as Ed Haislmaier, a senior research fellow at The Heritage Foundation, explained at a House Budget Committee meeting on January 24. Second, “Medicaid accounted for 81 percent of the incremental growth in enrollment in 2016,” and roughly the same goes for 2014 and 2015, according to Haislmaier.

So Medicaid expansion is great, right? Not even close, because (and third) every state to expand Medicaid under ACA has blown its budget – some states by a factor of four. This is true despite the federal government paying up to 100 percent of the cost of newly eligible enrollees in Medicaid expansion states. States and the federal government underestimated how many people would sign up for this entitlement program. The Centers for Medicare and Medicaid Services (CMS) have consistently underestimated what Medicaid expansion would cost.

CMS has also blocked states from implementing even negligible cost-sharing, premium, and copay requirements for able-bodied Medicaid expansion enrollees. Repealing this centerpiece of Obamacare would free states to make Medicaid compete.

Play the populist game, reassure the uninsurable, myth-bust Medicaid expansion – and Cruz has it. What could go wrong?

– Michael T. Hamilton ([email protected], @MikeFreeMarket) is a Heartland Institute research fellow and managing editor of Health Care News, author of the weekly Consumer Power Report, and host of the Health Care News Podcast.



Direct primary care (DPC) will end up playing a more prominent role on the national stage of conservative health reform. The Wall Street Journal considers this patient-centered delivery model the “fourth leg” to any plan that would replace Obamacare. Lawmakers in Congress and others in the consumer-driven health care scene strongly endorse DPC because it drives patients to pull more price transparency out of the very opaque U.S. health care system. And price transparency frequently comes with falling prices.

DPC works like a health care gym membership. In exchange for a membership fee (the industry average monthly payment ranges from $25 to $85), patients have access to around-the-clock primary health care. They can schedule same-day appointments and longer office visits with their doctors as needed. A major reason why monthly fees are affordable for the masses is because DPC practices have low overhead expenses since they do not accept insurance. For a more in-depth explanation on DPC, read here.

Health and Human Services (still yet to be appointed) Secretary Tom Price’s health care plan calls for expanding the presence of DPC by broadening the use of health savings accounts (HSAs) – accounts that can pay for medical expenses with pre-tax dollars. In his proposal, he specifies that patients can pay their DPC membership fees out of their HSA. For this to succeed, the tax code needs to be amended so that the IRS considers DPC fees to be a “qualified medical expense.” This policy change, combined with the fact that Price encourages patients on Medicare, Medicaid, and other government programs to become HSA holders, gives DPC a broader appeal for providers and patients alike.

It’s not just Price’s “Empowering Patients First Act” that recognizes DPC. The Primary Care Enhancement Act of 2017 along with the Health Savings Account Expansion Act also advocate for DPC fees to be paid for with an HSA. Either of these stand-alone bills can legalize such purchases if a tax code tweak doesn’t make it into a final health reform package.

It’s nice to see that the health care authors in Washington are eager to use HSAs as a vehicle to further incorporate a concept that has already proven to work in many “laboratories of democracy” across the United States. States are also testing DPC in other ways, too. …

SOURCE: Katherine Restrepo, Forbes


When Jolie and Chris Jenkins’ 7-year-old got sick last year with a recurring infection, the medical bills could have flattened the budget for the Walla Walla family of eight.

Their daughter’s care for the illness required two doctor visits, three lab tests and an ultrasound – with the latter procedure alone one that typically rings up at about $1,200, the couple said.

“If you take your kids to the emergency room at 2 a.m. for a cold, it’s like a $1,000,” Jolie said.

The Jenkins should know – Chris is an emergency medicine doctor for Walla Walla General Hospital. And despite health insurance available through his job, the Jenkins found their share of such coverage to be prohibitively expensive.

But Chris, 40, and Jolie, 34, chose long before their daughter got sick to opt for an alternative to traditional health insurance. The cost to treat their child: $500, with no copay to worry about.

That doesn’t mean they are breaking Affordable Care Act laws that require people to have medical insurance. The Jenkins, like hundreds of thousands of other Americans, have chosen to opt out of the health insurance fray altogether by joining a Christian-based organization focused on covering care costs.

“Health care sharing ministries” or “medical sharing plans,” as these alternative plans are coined, are offered by big and small faith-based nonprofits. Users are exempted from buying traditional insurance through a loophole in the present ACA model that allows religious organizations to share health care costs among members.

Thus for the Jenkins, care is not a matter of faith in the U.S. government – and whether ACA will survive a Republican Congress’ vow to repeal it – but simply a matter of faith. …

SOURCE: Sheila Hagar, The Union-Bulletin (Walla Walla, Washington)


A Republican proposal to fund Medicaid through block grants could save the federal government more than $100 billion over five years, according to a new analysis released Monday.

The analysis from healthcare firm Avalere Health shows that if Medicaid were funded through block grants instead of through the open-ended commitment the program receives now, the federal government would save $150 billion by 2022.

Similarly, shifting to per capita caps, in which states would receive a set amount of money per beneficiary, would save $110 billion over five years.

“Medicaid block grants and per capita caps serve as vehicles to control federal spending on the program and put more of the decision-making on things like covered services and program eligibility in the hands of the states,” said Avalere president Dan Mendelson.

Congressional Republicans argue that changing Medicaid’s funding mechanism would give states more control over their programs. Democrats say that beneficiaries would face slashed benefits under either proposal, while states would face more costs. …

SOURCE: Jessie Hellmann, The Hill


For the second time in two years, the North Dakota Board of Dental Examiners won’t allow expanded dental services in the state without a fight.

At issue is House Bill 1256, approved by a House committee last week and expected to hit the floor this week, possibly as soon as Tuesday. The measure would allow dental therapists to help address shortages of oral care in the state’s 35 federal dental health professional shortage areas.

These mid-level providers work under the supervision of dentists, and are licensed to perform many of the same procedures, such as fillings and tooth extractions. Right now, neighboring Minnesota has the only state-sponsored education and licensing program in the country, though Maine, Vermont and tribal lands in Oregon, Washington and Alaska have all authorized dental therapy.

Several other states are in the queue to consider expanding patient choice and access to oral care. In North Dakota, the effort is backed by a group of 15 organizations called North Dakotans for Dental Access which [includes] the North Dakota Dental Hygienists Association, the AARP and the North Dakota Public Health Association.

But during a hastily arranged conference call Feb. 2, the Board of Dental Examiners and its executive director, Rita Sommers, derided the bill for including “unprofessional terminology,” attempting to usurp board authority and taking advantage of legislators’ supposed lack of expertise. …

A representative of the University of North Dakota Center for Rural health testified at the Jan. 18 hearing that a statewide survey of licensed dentists showed 16 percent of respondents would participate in dental therapy, including 24 percent of rural dentists.

This calculates to about one in six entrepreneurial dentists willing to hire a dental therapist, about one in four in rural areas.

Michael Hamilton, a senior research fellow in health care policy at the free-market Heartland Institute and co-author of “The case for licensing dental therapists in North Dakota,” dismissed the last minute-attempt by the board to sway lawmakers.

“The board’s opposition to HB 1256 is fundamentally inconsistent and should fool no one,” he told “The board stakes its credibility on the fact its members are licensed dentists, so it has no rational basis for opposing a bill that would trust licensed dentists to use dental therapists safely.” …

SOURCE: Kathy Hoekstra,