Full Repeal Must Include the Regulatory Architecture of Obamacare

Background: On March 6th, House Republican Leadership released a long anticipated bill that partially repeals and replaces Obamacare named the American Health Care Act (H.R. 1628). Speaker Paul Ryan was forced to delay a vote on the AHCA before finally pulling it from the House floor due to lack of support among House Republicans – conservatives and moderates included. While the bill contains many provisions that should concern conservatives, the main problem with the repeal portion of the bill is the failure to repeal most of the insurance regulations that contribute to the rising cost of health care. The Republican proposal not only maintains the overall regulatory framework of Obamacare, but also subsidizes that regulatory framework through new refundable tax credits aimed to help individuals buy their own health care plans – plans that will remain highly regulated and overly expensive.

Obamacare Regulations Defined: The heart and soul of Obamacare contains numerous insurance mandates and regulations that restrict consumer choice and drive up the cost of health care premiums by as much as 68 percent. The four most problematic regulations include guaranteed issue, community rating, essential health benefits, and actuarial value.

1.) Guaranteed Issue: Prohibits insurance companies from denying customers regardless of their previous insurance history, which incentivizes potential customers to delay purchasing insurance until they need it. The guaranteed issue requirement necessitated the individual mandate in Obamacare, which has been replaced in the AHCA by the 30 percent surcharge in the individual market paid directly to insurance companies. Congress should address this issue by simply extending existing protections in the employer market to the individual market once Obamacare’s regulations have been repealed to solve the “waiting until you are sick to get coverage” issue.

2.) Community Rating: Prevents insurance companies from setting prices based on the age, health status and/or gender of the customer. The AHCA only moves the age rating ratio that Obamacare uses from 3:1 to 5:1, but does not address health status or gender.

3.) Essential Health Benefits: Outlaws inexpensive and customized health insurance plans by requiring insurance companies to cover comprehensive benefits, even unnecessary ones including maternity care for single males, specific rehabilitative services, preventive services, and others.

4.) Actuarial Value: Abolishes cheaper, catastrophic plans by requiring insurance companies to cover a certain percentage of total health care costs. The AHCA does get rid of this regulation, which is one of the only positive reforms in the bill.

Moderate Republicans have hidden behind the flimsy argument that Congress cannot repeal Obamacare’s insurance mandates and regulations through budget reconciliation because it does not have a clear budgetary impact. In reality, Obamacare’s regulatory architecture imposes significant costs on taxpayers and is inseparable from the rest of the law. These regulations are one of the main reasons why health care costs are rising and federal spending is increasing under this law. Congress has the legislative tool it needs to repeal Obamacare’s regulatory architecture through budget reconciliation and should maximize its use. Congress can address individuals priced out of the market with pre-existing conditions through alternative solutions such as state based high risk pools.

Full Obamacare Repeal: Republicans cannot maintain Obamacare’s regulatory structure and claim to have repealed the law. Without repealing these insurance regulations – the regulatory architecture of Obamacare – Republicans will fail to keep their seven year promise to fully repeal Obamacare, and health care costs will continue to rise. According to Heritage Action CEO Michael A. Needham:

“Many Americans seeking health insurance on the individual market will notice no significant difference between the Affordable Care Act (i.e., Obamacare) and the American Health Care Act. That is bad politics and, more importantly, bad policy. Rather than accept the flawed premises of Obamacare, congressional Republicans should fully repeal the failed law and begin a genuine effort to deliver on longstanding campaign promises that create a free market health care system that empowers patients and doctors.”

Obamacare Timeline Slipping: The ongoing delay over how much of Obamacare to repeal and what to replace it with has caused the timeline to slip. Further delays are pushing repeal past the congressional Easter recess and dangerously close to when the federal government runs out of funding on April 28th and when insurance companies must submit proposed premiums for 2018 Obamacare plans on May 3rd. Congress could quickly repeal first and then debate and pass free-market health care reform that lowers cost, increases choice, and restores the doctor-patient relationship.

Conclusion: Republicans promised to fully repeal Obamacare, including Title I regulations, campaigned and won on full repeal, and voted more than 60 times to repeal parts or all of the disastrous healthcare law. Congress can repeal Obamacare through modifications to the AHCA, through a new, more comprehensive rewrite, or by simply re-passing the 2015 repeal bill (H.R. 3762) with additional language repealing the insurance regulations. The 2015 bill was supported by nearly every single Republican, but ultimately vetoed by former President Barrack Obama in 2016.

Now that voters gave Republicans a unified government including the White House, there are no more excuses. Failure is not an option. Conservatives need to continue pushing for full repeal, including all of the Obamacare insurance regulations, as soon as possible by actively participating in town halls, writing letters to the editor, and contacting their member of Congress.

Please Share Your Thoughts

23 thoughts on “Full Repeal Must Include the Regulatory Architecture of Obamacare

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  2. Heritage Action is living in fantasyland because the ‘full repeal’ and the all the free market reforms we all want require 60 votes. The bill currently before congress does a lot of reforms that will bring downs costs including the medicaid reforms, high risk pools, and repeal of the actuarial value requirements. Yes, you can argue that more regulations should be repealed but you are going up against the parliamentarian in an argument about what fits under reconciliation, which is silly. Don’t torpedo the entire republican agenda and much needed healthcare reforms because of a tactical disagreement with Senate republicans.

  3. I totally and completely disagree with the Heritage position on this. Don’t screw around and give the Democrats a filibuster opportunity. Pass the dam present repeal bill.

  4. Please explain why this cannot be addressed in the proposed plan. This sells the plan! Some Republicans have argued Congress cannot repeal Obamacare’s insurance mandates and regulations through budget reconciliation because it does not have a clear budgetary impact. In reality, Obamacare’s regulatory architecture imposes significant costs on taxpayers and is inseparable from the rest of the law. These regulations are one of the main reasons why health care costs are rising and federal spending is increasing under this law. Congress has the legislative tool it needs to repeal Obamacare’s regulatory architecture through budget reconciliation.

    • I agree. Address Medicare and Medicaid in DHS and committees, have legislators approve changes. We want all of ACA repealed, new bill needs affordable access to healthcare, not unaffordable insurance. Choice in open market needed. Stop playing favorites and penalizing people. What Medicaid and Medicare has access to, so should all. Already have law that abortions are not funded by tax dollars. All organizations assisting family planning and services should be able to receive payment for services funded by Medicaid.

  5. Healthcare coverage as a federal entitlement is un-Constitutional. Interstate commerce is the only place the federal government can and should have a say. Opening up interstate markets for healthcare coverage can and should be done. Beyond that, we should just repeal the ACA and leave it to the states. Finding Constitutional ways to encourage individuals to buy HDHP’s with HSA’s is where I believe we need to go. I like the idea of “401K” type plans where employers match employee contributions to Health Savings Accounts. Showing young people the wisdom of this is where we need to concentrate messaging. Ultimately, we need to progressively do the same thing with Social Security…if we are to follow the US Constitution (see Article X of Bill of Rights). Encourage defined contribution “401K” plans to progressively replace illegal Federal Social Security “Insurance”. States can require these. The Federal government cannot and should not. Regarding Medicare, if our citizens begin fully funding their HSA’s when they are young, they won’t need Medicare/Medicaid either.


      • Yes, I understand but there will always be people in need no matter how much we tax people. The question is how do we fund their needs? Should the government force people to give to charitable causes via taxes? Should they be left to make that decision on their own? When all taxes are added together we can be taxes 40 – 50 pct. of what earn? Is this fair to the tax payer? The federal government through its ability to tax, forcibly collects charity from citizens. However, real freedom means that citizens decide and not the federal government on what charity to give to and how much to give. Should I be held responsible for my neighbor’s needs or should my neighbor be held accountable for his or her own needs.

  6. My opinion: Repeal and Replace. It is not complicated. Outline the fundamental, necessary issues and address them. Experts on the issues are available to congress. Use them! Learn from them! Create a bill that is efficient and effective for all parties concerned. Reasonable minds ought to be able to sit down and address the primary issues for the individual, medical care provider and business owner. And, unless you are uninformed as to what is really going on, there most certainly is an economic impact. That argument seems to be nothing more than an excuse to justify some side deal to keep certain things in place. Draft a Healthcare policy that is simple and straight forward. It doesn’t need to be 2700 pages long. Mediate a creative solution that is for the good of the people and commerce alike.

  7. The best way to get government out of health care is to increase the size of the pool. Why not eliminate Group Health and make everyone buy in? No individual mandate—just those who want to buy insurance. Eliminate all tax credits including the net of tax write-off for group plans. Level the playing field for everyone. That would drive costs down because insurance would not be benefiting from indirect subsides.

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  15. Disgusting. How do you justify supportingan effort to make the community rating provision optional. Having been dropped from my insurance Obama Care in between a two part surgery after having paid for insurance for years, I know how unfair Insurance companies behave given the opportunity. Your organization is a sham. Health insurance is useless it protects you when you need. Insuring more people not less is the best way to lower prices.

  16. Sure. Allow insurance companies to drop people that need health care while they make money on everyone else. Because the point of healthcare is to make money not to make money and offer something of value to society. Organizations like these exist to benefit big money interests and confuse regular citizens.

    By William J. Skinner
    Almost everyone knows healthcare cannot be provided for free; but many people assume or believe healthcare is their right. Many people are being pulled in this little red wagon and fewer people are making the payments. Meanwhile politicians promise to take more from wage earners and pass it along to others who will not work or are unqualified for available jobs to get votes. Americans are a generous people, but there are limits.

    Can we get more folks to participate in controlling the need for healthcare? Chronic diseases are very often caused by lifestyle choices – over eating, drinking unhealthy beverages, eating the wrong foods, and failure to exercise. Generally taking good care of oneself would be a good start to health. Good health is ignored by not washing the produce before eating it, neglecting to wash hands, and not knowing how to recognize common medical conditions or symptoms. Medical costs are driven up by going to the emergency room (ER) to get colds, sore throats, cuts, bruises and rashes treated. And because we over exercise our petition rights too much to make laws, Americans now need help at the ER for over eating marijuana cookies.

    Not all people ignore practicing good habits to stay healthy, but many do not know what to do and let their personal health situation get out of control. This ends up costing other people – the taxpayers – an ever increasing amount of out of control tax increases.

    We have now, in 2017, had seven years of experience in trying to pay for health insurance for 40 million uninsured plus millions of illegal immigrants with the Affordable Care Act or Obamacare. The plan was passed because of the “stupidity” of American voters according to Obamacare expert MIT professor Gruber. The ACA has proven to be unsuccessful in getting young healthy people to pay for the care of old, sick people and others.

    The threat of fines and taxes did not convince enough people to pay the premiums for ACA- defined “universal” insurance. Deductibles went up, the insurance exchanges were abandoned by profit losing insurance companies and the ACA proved it was poorly planned to be sustainable.

    We have more recently had a hard time determining what to do to get support for a new American Health Care Act. We know the structure of ACA will not work, but so far we insist on reproducing a lite version of ACA under another name.

    One of our problems is we do not have all of the people with skin in the game or a dog in the hunt, as politicians say. If it is not too late to get our elected representatives to address this critical factor, we could still get more people in the fight to bring down health care costs. We need to try to achieve the attention of every American, young and old, in the next plan. How can we do that? Start by thinking outside of the traditional box and use our human resources is one way to describe our solutions to this effort. Those who have read Alexis de Tocqueville may remember he wrote: “The health of a democratic society may be measured by the quality of functions performed by private citizens.” He did not say by government run health programs.

    Use the Education Techniques and Resources of Voluntary Associations

    Youth Organizations
    Some of the most obvious providers of health education are youth organizations and disease organizations. In the area of youth, for example, the Boy Scouts of America (BSA) incorporates first aid and health education throughout its program for boys from ages six to 18 and beyond. Each rank advancement has some health component as a requirement for an award. There are specific individual requirements, like using a tourniquet, and there are groups of issues combined in Merit Badges for many areas, like First Aid, Emergency Preparedness, Personal Fitness, and many others.

    Especially important, these youth organizations already have the materials and educational transfer mechanisms in place, so thousands of people could be educated to the BSA standards in a shorter time than any other mechanism I know about. We do not need to set up another governmental office to construct a new program. We need to apply what we already do voluntarily as requirements to get government health services. Recipients of taxpayer supported health care services ought to be able to test out at certain levels of personal knowledge to qualify for having others pay for their health care.

    Special provisions will be needed for those who prove to be too lazy or adamant about doing nothing to improve their personal situation. Some will be mentally or physically challenged and will not be able to participate in such programs, but this is a small number that most Americans will be ready to help because of their situation. Waivers or equivalent certifications can be granted by government bureaucrats after the standards are written into law and regulations are properly promulgated using the Administrative Procedures Act to allow the population to learn about the program. But the basic idea is that if you have not earned First Aid Merit Badge or the equivalent, you cannot get ER soap and water with bandages applied.

    This is not a time for government to start dictating how voluntary youth organizations should operate, but only a time for government to get some assistance from what Americans have always done – they help each other. This is not a time to assign the task to government run schools and throw money at the problem so that politicians can have something else to control.
    America for several years has been spending more and more on government/union schools and its students are fast losing rankings in educational levels among other nations of the world.

    I was personally involved in the BSA from 1948 through 2014 – a period of 66 years and the only time I was paid was the few weeks I worked on a camp staff during three summers in my high school and college years. Thousands of volunteers would be willing to gear up to help other youth and adults learn what they need to know to improve their health care.

    The Girl Scouts, 4H Clubs, Campfire, some youth organizations sponsored by religious groups like YMCAs, and a variety of charitable youth organizations could be interested in becoming involved.

    Disease and Disaster Associations
    The American Heart Association does a great job teaching adults and youth about cardio pulmonary resuscitation (CPR), they even do it with an online program. AHA has an instructor program already in operation and could take on larger groups that need such training. AHA is a leader in resuscitation science, education, and training, and publisher of the official AHA Guidelines for CPR and ECC. More than 10 types of instructional programs are offered, and many of these would be useful for affected individuals and families to learn about.

    Specific disease associations that specialize in diabetes, lungs, kidneys, cancer, feet, skin, and you name it often have educational programs for professionals, family members and individuals. Use their programs to help educate patients and families how to care for their illnesses. Some of these voluntary associations have magazines offering advice and information. These groups could develop certification programs to qualify for eligibility for taxpayer funded health care.

    The American Red Cross offers courses for instructors and individuals in five basic areas:

    The AP/LTP area has training with specific courses on Aquatics, Blood borne Pathogens Training / Babysitter’s Training, Professional Rescuers and Healthcare Providers, Responding to Emergencies, Lay Responder and Wilderness and Remote First Aid / Preparedness.

    Some disease foundations have set up patient support web sites that can be used to reduce patient costs on government funds, e.g. taxpayer funds.

    Underused Health Professionals
    Pharmacists should be consulted for advice about the use of prescription drugs, vaccines, drug interactions and side effects, over the counter drugs, health resources, and devices. If pharmacists were reimbursed for their time, patients would learn more about their health needs from this easy to reach professional resource in every American town.

    Many patient disease-related support groups have participating social workers, physical therapists, and other health professionals. For example diabetes, Parkinson’s disease and movement disorders, weight management and other conditions often have support groups available to orient patients and family care givers.

    What To Do Now

    Everyone receiving taxpayer funded healthcare should be encouraged to participate in these various volunteer certification programs to show they understand what they can do to help themselves. Let your state and federal legislators know how you feel about this general idea. Urge them to consider it. Think about how these kind of programs could help you with your health care or that of a family member or friend. Let us work together to solve these problems. Do not give up and just ride in the little red wagon. 4-4-2017

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