A Step-By-Step Approach To Congress’ 2015 ObamaCare Strategy

By Grace-Marie Turner

If Republicans take control of the Senate in today’s elections, the new Congress will need a three-part strategy on ObamaCare – the one they follow after they take the repeal show vote.

Over the last four years, the House of Representatives has been methodically passing bills to repeal of some of the most egregious provisions in the health law, but most of them have hit a brick wall in the Senate.  That would change next year as bill after bill passed by both houses hits President Obama’s desk.

The president still retains veto power, and no one believes that there will be two-thirds majorities in both houses to override his certain veto of any full repeal bill.  Next, the Congress can begin a serious legislative and oversight strategy to:

  • Halt provisions of the law that are doing the most harm to our health sector and economy
  • Demonstrate their positive vision of free-market reform that includes a safety net for those receiving coverage now
  • Conduct oversight of the many unlawful changes and blank checks the administration has been writing in implementing ObamaCare.

Senate Republican Leader Mitch McConnell spoke with Neil Cavuto on Fox News last week about the possibilities of full repeal:

MCCONNELL: Well, it would take 60 votes in the Senate. No one thinks we’re going to have 60 Republicans.
 
CAVUTO: Right. Right.
 
MCCONNELL: And it would take a president — presidential signature. And no one thinks we’re going to get that.
 
So the question is, what can you do about it? Well, I would like to put the Senate Democrats in the position of voting on the most unpopular parts of this law and see if we can put it on the president’s desk and make him take real ownership of this highly destructive Obamacare, which has done so much damage to the country, the lost jobs, the higher premiums, the higher co-payments, the higher deductibles.
 
Yes, we will be voting on that sort of thing. But he is the president of the United States until January of 2017, and people need to understand that that constrains our ability to do for this law what we’d like to do, which is to get rid of it.

In response to the expected firestorm from conservatives following his remarks, McConnell spokesman Brian McGuire assured reporters the Leader “is and has always been committed to the full repeal of Obamacare.”

Since Republicans took control of the House in 2010, they have passed more than 50 bills to repeal, replace, defund, dismantle, and delay the law. House Speaker John Boehner’s strategy has been “a step by step approach to common sense reform” that has resulted in 10 ObamaCare repeal bills that have passed and been signed into law by President Obama.  All had bi-partisan support.  These included repeal of the long-term care CLASS Act, eliminating the onerous 1099 tax reporting requirement that threatened to bury small businesses in pointless paperwork, and cutting off funds for creation of more of the troubled health insurance co-ops.

A new Republican Congress will need to continue to follow this step-by-step approach to reform and use the next two years to pass targeted bills that will show the American people the changes they would make after 2017 when they don’t face President Obama’s hostile veto pen.

The targeted approach would give Republicans a chance to demonstrate their very different vision for health reform that puts doctors and patients in charge of health care decisions, gives people more choices of plans and providers, encourages genuine competition, provides portability of coverage, and unlocks the onerous mandates that restrict choice and drive up costs.

The first target likely will be repealing the most immediately destructive provisions of ObamaCare.

  • The employer mandate must be on the chopping block.  Even Democrats now are admitting that this mandate is unnecessary.  It encourages companies to cut the hours of workers to below the 30-hour-a-week threshold, it punishes businesses that grow beyond 50 employees, and it burdens employers with mountains of unproductive paperwork.  The employer mandate especially discourages creation of entry-level jobs for those who most need to get started in their careers.
  • The individual mandate remains the most unpopular provision in this very unpopular law and will become more so when people have to start paying the fine for not having insurance. Requiring citizens to spend their own personal money on a private product dictated by government is an affront to freedom, no matter what the Supreme Court ruled, and it has to go.  And when it goes, provisions requiring insurance companies to sell coverage to all comers and restrictive rating restrictions would have to go as well.
  • Repealing the unelected, unaccountable, and as yet unappointed Independent Payment Advisory Board before it can begin rationing medical care would have broad bipartisan support.
  • The contraceptive mandate and its affront to religious freedom could be repealed as part of eliminating ObamaCare’s list of mandatory “essential” benefits wherein government rather than families decide what health insurance covers.
  • The onerous ObamaCare taxes would likely be a next target, starting with the punitive tax on the revenues of medical device companies.  Legislation to repeal this tax has broad bi-partisan support in Congress and would quickly pass, and if the president were to veto it, there could be enough support for an override. Other targets would be the $100 tax on health insurance that further inflates premium costs and onerous taxes on investors and jobs creators.

In addition, both houses of Congress will be actively involved in oversight of how taxpayer dollars are being spent, from ObamaCare applicants’ “self-attestation” of their subsidy eligibility and the impact of $716 in Medicare cuts, to the workings of the problem-prone co-ops designed to appease the “public option” proponents.

Court challenges to ObamaCare could also direct the agenda of the next Congress if the Supreme Court were to decide that the law actually means what it says and that insurance subsidies are only available through exchanges created by states, contrary to the IRS rule allowing subsidies to flow through federal exchanges as well.

ObamaCare supporters say a court decision striking down the IRS rule means the 36 states relying on the federal exchange would be forced to create their own exchanges or leave millions of their citizens without subsidies and health insurance.  But that is only if the law remains unchanged.  The decision could instead open the door for Congress to offer alternatives.

Congress would have to create a safety net for the millions of people who are currently getting subsidized coverage in federal exchanges under ObamaCare.  Many of them lost the private coverage they had because of ObamaCare and were thrown into the exchanges.  Eighty-seven percent are getting subsidies for their expensive ObamaCare-mandated coverage.  They cannot be left high and dry.

Political leaders and policy experts across the political spectrum have long supported providing refundable tax credits to help the uninsured get coverage.  But in providing its own extravagantly complex version of these subsidies, ObamaCare created a mountain of regulations that suffocate competition and require people to purchase coverage that is much more expensive than most would have chosen for themselves.

A new Congress could extend targeted tax credits to those who currently are receiving coverage in the exchanges, laying the groundwork for a broader system of more sensible subsidies –replacing the current convoluted, regressive system – in the next phase of reform.  This could be coupled with assurances that people who have health insurance can keep it through guaranteed renewal of health insurance and not see their premiums soar if they get sick.

It only takes 51 votes in the Senate to pass many of these provisions; the process of “reconciliation” requires a simple majority as long as the provisions are related to taxes and the budget.

This step-by-step approach will show the American people that conservatives are working to protect them from the aggressive overreach of the federal government and are offering a free-market, consumer-friendly agenda.

An earlier version of this article was posted on Forbes, October 31, 2014 

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