Republicans must push through genuine health care reform

After a failed attempt at reforming health care in the last Congress, Republicans seem in danger of letting the issue become their own third rail of politics. If they do, there will be far less in the way of stopping a Democratic Party that is devouring any hint of moderation. 

The president understands his party has no choice but to offer an alternative to ObamaCare, even if the traditionally cautious Beltway mindset doesn’t. So does the public. Why else would Democrats be so eager to implement a $32 trillion takeover of private health care, even ending employer-sponsored insurance, if the Affordable Care Act was performing as promised? 

Because in their heart of hearts, no one really thinks ObamaCare is working. So c’mon, let’s have a show of hands. How many Democrats think we should leave the ACA just like it is? No more taxpayer subsidies for big insurance. No more waivers for politically-favored groups to get out from under the punishing business mandates. No stop to spiraling premiums, rising deductibles and shrinking drug formularies

Indeed, the problem of drug costs is as much a lack of coverage as it is rising prices. Prices that should be transparent for not only pharmaceuticals, but PBMs, hospitals and clinics. 

I have been on two different ObamaCare exchanges—in and out of Congress—and it’s simply not sustainable. A new GAO report released this year confirms that insurers “raised their premiums from 2014-2018 and projected more increases in 2019.” That’s why Democrats are seeking a federal ‘reinsurance’ bailout and insurers keep ‘silver loading’ costs to garner the maximum tax credit payments from government coffers.

The fact is ObamaCare attempted to take away health care choice and the architects of Medicare for All want to finish the job. Yet for all this, opposing socialized medicine isn’t enough.

The GOP needs to lean-in with a new proposal that guarantees lower premiums, catastrophic coverage and a private, portable plan for everyone—including those with preexisting conditions. 

And it starts by treating employees the same way we do employers. That is, workers should be able to deduct the cost of an individual plan and take it with them should they lose their job. That would be especially beneficial for those later in life when health problems often materialize.

While Democrats are rightly getting nicked for their scheme to end employer-sponsored insurance, the issue of ‘job lock’ is real. Forcing people into socialized medicine is not the right answer—tax equity with large corporations is.

The new HHS rule allowing employees covered by Heath Reimbursement Accounts to pay for premiums with pre-tax dollars is big step in the right direction. So would an expansion of Health Savings Accounts.

Just as important, making individual plans affordable should remain the centerpiece of Republican reform efforts. That means removing the onerous mandates and price controls of the ACA thus encouraging the pooling of risk by letting markets price it. That’s precisely what’s been done for decades under Kennedy-Kassebaum (HIPPA) in an employer-based market 160 million Americans want to keep.

Right now, to be ACA-compliant, consumers have been effectively forced to over-insure resulting in singles buying pediatric dental coverage or those beyond childbearing age getting covered for maternity and newborn care. There is simply no debate that removing regulations like these would lower prices.

ObamaCare, instead of encouraging continuous coverage through lower prices, sought to fine (er, ah…tax) people for not buying insurance they couldn’t afford. But unless the cost approached that of a high-priced policy, people were bound to game the system by waiting until they were sick to buy insurance. Repealing the individual penalty merely codified the ‘moral hazard.’ 

By combining market reform with invisible high-risk pools (like the successful Minnesota Comprehensive Health Association available before ObamaCare), you lower the cost of health plans for the young and healthy while ensuring coverage for the hard to insure. 

Opponents will no doubt continue to fear-monger. While the CBO had predicted over 25 million enrollees on the ObamaCare exchanges by now, the latest federal numbers for 2019 show just 11.4 million. Which of course exposes the oft-repeated midterm liberal lie that 23 million would lose their coverage should the ACA be mothballed? 

To be sure, Medicaid expansion plays a role here. But it too is unsustainable. 

The $500 billion program, the nation’s fastest growing entitlement, covering half of all births in the United States. So naturally, Democrats are working hard to extend its coverage to undocumented immigrants.

In Minnesota, Medicaid expansion has added more than 200,000 enrollees—one reason why the state just reinstated a tax on health care providers that was set to expire. Moreover, about one-fifth of the state’s Medicaid recipients are now childless, able-bodied adults. Returning Medicaid to its core mission covering the truly indigent and embracing reasonable work requirements for non-disabled adults would not only be fiscally prudent, but popular.

Again, that show of hands of those who think it’s wise for the federal government to finance Medicaid expansion for non-disabled adults at 95 percent but at half that rate for poor mothers, the elderly and disabled?

Contrary to conventional wisdom, enacting genuine health care reform and removing the last albatross from an already burgeoning economy would not detract from GOP fortunes, but would herald in a new Republican majority for years to come.

Jason Lewis represented Minnesota’s 2nd District in the 115th Congress.