With a “full” Affordable Care Act repeal and a “skinny” repeal also lacking votes to pass the U.S. Senate, it is looking more and more likely the bulk of Obamacare isn’t going anywhere—at least not anytime soon.
Instead of sitting idly by as Washington, DC continues to stall and wring its hands over reforming our health care system, states should take steps to reform Medicaid and roll back other government intrusions in the health care marketplace.
Matthew Glans, Heartland senior policy analyst, recommends: “Instead of being reactive to what’s happening in Washington, DC, state lawmakers should apply for waivers from the U.S. Department of Health and Human Services (HHS) to allow for more control over their Medicaid programs, shifting the paradigm away from health insurance and toward health care.”
While the Obama administration rejected most of the waivers submitted by states, Dr. Tom Price, secretary of HHS, has been a proponent of waivers and would likely provide states with the flexibility they need to improve their broken systems.
Glans has outlined 10 ways to improve health care at the state level, such as expanding high-risk pools for people with pre-existing conditions. As Glans explains, “Before ACA, 35 states covered these individuals through high-risk pools, state-chartered, nonprofit associations offering comprehensive health insurance through the private market.”
Other steps include eliminating unnecessary state insurance benefit mandates, expanding access to health savings accounts, rolling back certificate of need laws, and encouraging price transparency.
The Medicaid expansion provision of Obamacare decreased eligibility requirements for the program, resulting in more Medicaid recipients, which has put even more financial strain on states than expected. Lawmakers in these states can roll back and reform their Medicaid expansion, as those in Arkansas, Indiana, and Kentucky have successfully done and what lawmakers in Ohio and Oregon attempted to do this year.
Arkansas’ Medicaid rollback includes capping eligibility for those with an income 100 percent of the federal poverty level, down from 138 percent under Obamacare’s Medicaid expansion, reducing the state’s enrollment by 60,000 people.
Indiana and Kentucky have also submitted waivers to the Centers for Medicare and Medicaid Services, requesting similar work requirements for able-bodied adults without dependents to work at least 20 hours per week or to be in a job-search or training program. These work requirements mirror those crucial to the immensely successful federal welfare reforms of the 1990s, which greatly reduced national poverty rates.
A true free market in health care would lower costs for consumers by creating competition among care providers and insurance companies and allowing even the most vulnerable populations to have access to these groups.
State lawmakers should not wait on Congress to fix or roll back Obamacare. After all, Congress may never accomplish that goal. Instead, state lawmakers should move forward and implement the necessary solutions through the waiver process, rolling back unnecessary state regulations.
Energy & Environment
Research & Commentary: Study Proposing 100 Percent Renewable Energy By 2050 Is a Pipedream
In this Research & Commentary, Heartland Policy Analyst Tim Benson writes about a new analysis by 21 scientists and academicians published in the Proceedings of the National Academy of Sciences (PNAS) that offers a thorough, devastating critique of a 2015 Stanford University study claiming the United States could jettison all fossil fuels and rely solely on renewable-energy sources by 2050. The Stanford study has been promoted by radical environmentalists such as Bill McKibben to argue states should ban the practice of hydraulic fracturing, also known as “fracking,” to recover oil and natural gas. According to the PNAS analysis, the Stanford study used “invalid modeling tools, contained modeling errors and made implausible and inadequately supported assumptions.” These “numerous shortcomings and errors render [the author] unreliable as a guide about the likely cost, technical reliability, or feasibility of a 100 percent wind, solar, and hydroelectric power system.” Read more
School ‘Staffing Surge’ a ‘Costly Failure,’ Report Says
In this article for School Reform News, former Heartland Intern Tori Hart writes about a new report from EdChoice, authored by Benjamin Scafidi and titled Back to the Staffing Surge. It details the dramatic rise in non-teaching staff in public schools over the past 65 years. During that period, while the student population has grown by only 100 percent, teaching staff has grown by 243 percent and non-teaching staff has grown by an astounding 700 percent. Leslie Hiner, vice president of programs at EdChoice, told Hart “public school teachers could have seen an $11,000 increase in their [annual] salaries if the increase in nonteaching personnel would have kept pace with, instead of wildly exceeding, the increase in students.” Read more
Budget & Tax
Research & Commentary: Establishing Work Requirements for SNAP Has and Can Work
In this Research & Commentary, Senior Policy Analyst Matthew Glans examines the efforts by several states to add work requirements to their food stamp programs and the effect the reforms have had on enrollment. “States should have an immediate requirement for recipients to engage in work-related activities to be eligible for TANF and food stamps. States should also reform assistance programs that trap low-income Americans in poverty by disincentivizing work,” wrote Glans. Read more
John Garven: The State of Health Care Under the Affordable Care Act
In this edition of the Heartland Daily Podcast, John Garven, president and founder of Benico, Ltd., discusses the state of health care before and during the Affordable Care Act, the expansion of Medicaid, and the failures of Republican senators to repeal and replace Obamacare. Listen here
From Our Free-Market Friends
San Antonio’s Plastic Bag Blunder
Kirbie Ferrell at the Texas Public Policy Foundation writes about an attempt by environmentalists in San Antonio to push for the newly elected administration in the city to ban plastic bags. The city of Laredo considered this policy in 2016, but the state’s Fourth Court of Appeals ruled cities do not have jurisdiction to regulate containers or packages. San Antonio is also in the Fourth Court’s jurisdiction. Ferrell says it is worth watching to see if the city government follows the rule of law or attempts to circumvent it in the name of fighting the alleged dangers of plastic bags. Read more