Repeal and Replace
House of Representatives
March 21, 2017
Any discussion of the American Health Care Act needs first to consider where we will be without it. Obamacare is collapsing. More people are paying the steep tax penalty or claiming hardship exemptions than are choosing to buy Obamacare policies. In a third of the counties across America, there is only one provider to choose and soon we will see counties where there are no providers at all. Obamacare premiums soared an average of 25 percent last year, and we’re warned this year will be worse.
I have strongly advocated that the House address this crisis in a single comprehensive bill that fully repeals Obamacare and replaces it with a healthy, competitive market.
Instead, we rely on the reconciliation process to bypass Democratic obstructionism in the Senate. This only allows us to repeal parts of Obamacare and enact only parts of a replacement. Finishing the job will require administrative actions and follow-up legislation requiring Senate Democrats to cooperate – something not very likely. So we need to ask if this bill alone is enough to produce a better healthcare system for the vast majority of people.
Its biggest defects are its failure to restore to consumers the freedom to shop across state lines and to fully free consumers from purchasing coverage they don’t need and don’t want. I fear that in states where insurance commissioners refuse to approve innovative replacement plans, consumers will be stuck in a market still governed by Obamacare mandates.
Critics cite the Congressional Budget Office estimate that “24 million Americans will lose their coverage.” But this conclusion is based largely on the premise that unless people are forced to buy health insurance, they won’t. In fact, people won’t buy health insurance that’s not a good value for them – and clearly Obamacare isn’t. We envision a vigorous buyers’ market where plans across the country compete to offer consumers better services at lower costs, tailored to their own needs and wants.
And this is the AHCA’s biggest achievement: replacing coercion with choice for every American. It ends the individual mandate that forces Americans to buy products they don’t want. It ends the employer mandate that has trapped many low-income workers in part-time jobs. It begins to restore consumers’ freedom of choice -- the best guarantee of quality and value in any market. It allows Americans to meet more of their health-care needs with pre-tax dollars. It relieves the premium base of the enormous costs of pre-existing conditions by moving them to a block-granted assigned risk pool.
In making this transition, though, it’s important to leave no one in the lurch. That’s where we need to heed the CBO’s warning.
The fact that many low-income families could no longer afford basic health care is what produced Obamacare. When fully implemented, our reforms will correct the government mandates that trapped people in restricted markets that forced healthcare out of reach. But until then, the CBO warns that a 64-year old, for example, earning $26,500 will see her out-of-pocket health costs balloon from $1,700 to $14,600 per year. This is neither morally defensible nor politically sustainable.
The Budget Committee adopted my motion on a bipartisan vote to ask the House to correct this inequity by adjusting the tax credits to assure that health plans are within the financial reach of every family. I want to thank the leadership for responding to this motion by creating architecture in the bill to shift an additional $75 billion for this purpose.
As our pro-growth economic reforms cause incomes to rise and our health care reforms bring costs down, families will earn more and pay less for their health care, and reliance on these tax credits will recede. But we need a bridge from the present to the future, and we simply can’t get there without addressing the bill’s initial impact on older, low-income Americans.
It is also important that we assure stability in the Medicaid system as we transition to flexible state-run programs that correct the inequities of Obamacare that have pushed the elderly, blind and disabled to the back of the Medicaid line. This bill does so.
I wish it did everything necessary to restore an optimal health insurance market. But it moves us toward that goal, and even as a stand-alone measure, I am confident it will ultimately create a market in most states that will produce better services, greater choices and lower costs for the vast majority of Americans.