In his first address to a joint session of Congress, on February 28, President Donald Trump will outline his vision for strengthening the U.S. military, securing the nation’s borders, potentially overhauling the federal government’s budget, and replacing the Affordable Care Act (ACA). This will be a one-sided matchup between a president with record-setting productivity in his first six weeks and a Congress that has little to show after its first nine weeks, despite Republican control of the House, Senate, and White House.
Trump’s action against ACA to date qualifies him to scold congressional Republican leadership for failing to prepare adequately in the past eight years to replace Obamacare. Speaker of the House Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY) have so far failed to definitively back any of the several replacement plans members of Congress have proposed.
Trump has yet to unveil specifics of his oft-promised Obamacare replacement plan, and he has sent mixed messages about what a replacement plan must include. Nevertheless, a tally of Trump’s actions against Obamacare speak louder than his words.
As early as November 29, 2016, then-President-elect Trump sounded the death knell for Obamacare by nominating then-Rep. Tom Price (R-GA) to lead the Department of Health and Human Services (HHS). Price had introduced legislation to repeal ACA in every session of Congress since it became law in 2010. The U.S. Senate confirmed Price 52-47 on February 9.
Another Obamacare slayer Trump tapped early on is Vice President Mike Pence, whose address at a Republican Governors Association conference one week after the election caused South Dakota Gov. Dennis Daugaard (R) to abandon his plans to expand Medicaid under ACA. In addition, Trump has nominated Seema Verma to lead the Centers for Medicare and Medicaid Services. Verma previously developed the Healthy Indiana Plan, possibly the least-flawed Medicaid expansion plan among the 32 states that extended the ACA health insurance entitlement to able-bodied adults with incomes above the federal poverty line.
Trump took aim at Obamacare within hours of taking the presidential oath of office on January 20. One of his first executive orders, titled “Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal,” instructed executive-branch departments and agencies to slow implementation of ACA as far as current law permits.
The greatest achievement of this order was underreported. The order emphasizes the executive branch is bound by the U.S. Constitution to implement laws passed by Congress, including laws the chief executive dislikes. Contrast Trump with former President Barack Obama, who gloated in 2014 that instead of “waiting for legislation” to arrive from Congress, “I’ve got a pen and I’ve got a phone.”
It’s ironic Trump chose to use his executive order regarding a law he loathes to signal that “in America, the law is king” (as Thomas Paine wrote in 1776). This is a better use of Obamacare, however, than Democrats or Republicans could have imagined. As I wrote at The Hill at the time, “Strict constructionists interpreting the Constitution according to the Framers’ original intent do not want a ‘Republican Obama’ who flouts bad laws. We want a Congress that replaces bad laws with good ones, and we want an executive responsive to but not controlled by Congress or the Supreme Court.”
Stemming directly from Trump’s Obamacare executive order, the Internal Revenue Service (IRS) canceled a rule the Obama administration had scheduled to apply to 2016 tax returns. Obama’s IRS would have rejected the tax returns of filers who failed or refused to check a box indicating they complied with ACA’s individual mandate, which requires individuals to buy insurance or pay a tax penalty.
Although Trump lacks authority to abolish the individual mandate and penalty, Trump’s IRS has made it easier for Americans to file their taxes. Simply put, Trump refuses to make tax returns and the patients filing them the hostages of Obamacare.
The new Congress’s indecision regarding ACA has relegated the legislative branch to a perversely responsive role. Instead of responding to the voters who elected them and Trump largely due to their promises to repeal Obamacare, congressional Republican leadership is forever responding to Trump.
Expect Trump to scold them for it, and watch them respond.
– Michael T. Hamilton (mhamiltonheartland.org, @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.
IN THIS ISSUE:
- New Heartland Policy Booklet: Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking
When President Trump addresses a joint session of Congress tonight, he should make health care reform the centerpiece of his remarks, and he should make it clear to congressional Republicans what he has in mind. Ideally, he should strongly support repeal, even if a replacement plan isn’t ready to go. …
So far, Trump has been hopelessly muddled on the issue. During his campaign, he promised to replace Obamacare with something “terrific” that would “take care of everybody.” On Monday, he told reporters that “nobody knew that health care could be so complicated,” and suggested Republicans should just “let it be a disaster,” and blame it on Democrats and Obama.
At this point, letting Obamacare collapse under its own weight is [a] bad idea. It made sense when Obama occupied the White House, but now that Republicans control the legislative and executive branches, it’s their responsibility to do something about it. But they need not craft a GOP version of the law with all the same pitfalls and costs as Obamacare. Instead, they should repeal the law and make a forceful case for health care federalism: states, not the federal government, should be the primary regulators of health insurance. …
Of all the damage Obamacare has done, perhaps the most structurally important has been the federal takeover of health insurance markets. …
Congress could repeal major tax and spending provisions of the law through the reconciliation process, as they are reportedly preparing to do, then invite states to step in and “replace”-or recreate-elements of Obamacare if they so choose.
Take Medicaid expansion. Despite the media’s specious refrain that the ACA has covered 20 million people, the vast majority of coverage gains under Obamacare have come from Medicaid expansion, the federal-state program originally created to provide coverage for the frail elderly, the disabled, and women and children. …
One compromise floating around is to temporarily keep funding for those currently enrolled in expansion states but block future funding. At the same time, the federal government would make new funds available to non-expansion states to offset the costs incurred by hospitals that treat large numbers of poor and indigent patients.
It’s a horrible idea. The federal government inflates state budgets (and therefore controls state policymaking) enough as it is. The last thing we need are more entitlement programs that enmesh states in federal policy schemes. …
Instead, Congress should say to states, “if you like your expansion, you can keep it.” Of course, there would be a catch: states would have to pay for the expansion population based on the old Medicaid reimbursement rates. …
Repealing the enhanced funding would not only reduce federal leverage over state agencies, it would rectify the disparity between expansion and non-expansion states. If expansion states really want to keep covering all those newly eligible enrollees, they will simply have to pay for more of the coverage costs themselves.
After all, states are taxing entities. There’s nothing to stop lawmakers in, say, California from increasing taxes to pay for more generous Medicaid coverage in their state. If voters in Oregon want their Medicaid program to cover able-bodied, working-age adults with no children, by all means they should go ahead. Even before the ACA, Medicaid programs varied widely from state to state, with blue states generally offering more generous benefits than red states. There’s no reason that can’t continue.
The same goes for individual health insurance markets. …
All of this goes back to a core constitutional principle of federalism. Just because Obama and the Democrats tried to nationalize health care doesn’t mean Republicans should tie themselves in knots trying to make Obamacare palatable-or functional. If they really want it, let the states have at it.
SOURCE: John D. Davidson, The Federalist
A bill to expand Medicaid services in Kansas won approval in the House on Thursday after years of effort by advocates.
The vote was 81-44, a strong show of support for expansion but not enough to override a potential veto from Gov. Sam Brownback, who opposes it. The bill still must go to the Senate.
Medicaid, called KanCare in Kansas, is the government insurance program for people who have low incomes or who are disabled.
Hospitals and health groups have pushed for years for the state to expand eligibility to more than 150,000 Kansans under the provisions of the Affordable Care Act. Kansas is among nearly 20 states that have resisted expanding the federal program.
“There are thousands of hard-working Kansans that deserve access to health care,” said Rep. John Eplee, R-Atchison, contending Medicaid expansion could be done responsibly in Kansas.
The proposal would establish a health insurance program in Kansas for people who make less than 133 percent of the federal poverty level.
The federal government would pay for most of the costs. Advocates say many of those federal dollars would help hospitals across the state, particularly those in rural areas vulnerable to closing.
Opponents cite concerns about costs and point to congressional efforts to repeal the Affordable Care Act.
Brownback has opposed expanding Medicaid throughout his tenure, pointing mainly to the cost.
“Kansas should not tie itself to this failed program of the past just before its inevitable demise,” he said in a statement earlier this month. …
SOURCE: Daniel Salazar, The Witchita Eagle
A recent oped in The Hill by MedShadow Foundation founder Suzanne Robotti claims that permitting Americans to import prescription drugs from Canada would save dollars and lives.
It would do neither. Prescription drug importation has several notable proponents, like Sens. John McCain (R-Ariz.), Amy Klobuchar (D-Minn.), and Bernie Sanders (I-Vt.), along with President Donald Trump. Without question, all of them sincerely want to make medicines more affordable. But importation wouldn’t save patients much money.
Instead, it would hamstring the Food and Drug Administration’s (FDA) ability to protect American patients and slow the rate of medical innovation.
Time and time again, the FDA has warned the public that it cannot guarantee the safety of imported drugs. Former Commissioner Margaret Hamburg, for instance, has extensively cautioned against the threat of counterfeit or adulterated medicines from abroad.
In response, many lawmakers now advocate for more limited “re-importation” policies that would permit Americans to purchase price-controlled medicines from Canadian pharmacies only if the drugs were originally manufactured in the United States.
Voilà – the dangerous drugs argument becomes null and void, right?
Not quite. It would be virtually impossible to ensure consumers only buy drugs from “reputable” pharmacies. There are more than 3,400 rogue online pharmacies. And these sites can look quite legitimate – a major online Canadian pharmacy recently smuggled nearly $80 million of unapproved drugs into the United States.
Even if every single imported pill was safe and legitimate, Americans wouldn’t save as much money as re-importation advocates claim. In fact, consumers’ actual savings would be less than one percent of total drug spending, according to the U.S. Department of Health and Human Services.
In part, that’s because Canada would restrict exports to Americans to prevent local medicine shortages. …
Only 20 percent of drugs generate enough revenue to match their development costs.
Allowing drug re-importation would make it much harder to earn a return on investment. If Americans start purchasing drugs at below-market prices, revenues would collapse. Drug developers would have no choice but to throw in the towel on the next line of breakthrough treatments.
That’d be tragic not just for patients, but for society too. Developing cures for diseases like Alzheimer’s – which will cost the nation over a trillion dollars annually by 2050 – is the surest strategy to meaningfully reduce healthcare spending.
American medical innovation – not the re-importation of price-controlled drugs – is the only way to save dollars and lives. …
SOURCE: Sally Pipes, Pacific Research Institute, The Hill
Policymakers should be mindful of the extensive research that supports tobacco harm reduction and understand that bans, excessive regulations, or high taxes on e-cigarettes could encourage smokers to stay with more-harmful traditional cigarettes.
For decades, lawmakers and regulators have used taxes, bans, and strong regulations in an attempt to reduce the negative health effects of smoking. Recently, some have sought to extend those policies to electronic cigarettes. This booklet urges policymakers to re-think that tax-and-regulate strategy.
Health professionals have long known that the smoke created by combustible cigarettes, rather than the nicotine, is what makes smoking harmful. Smokeless tobacco and e-cigarettes provide a much safer and healthier alternative delivery system for nicotine. Tobacco harm reduction is a proven strategy for helping smokers reduce their tobacco use or quit altogether.
SOURCE: Dr. Brad Rodu, Matthew Glans, and Lindsey Stroud; The Heartland Institute