Congress Prepares To Unveil Repeal With Replace Legislation

We will have, over the next few weeks, a once-in-a-generation opportunity to get our health sector back on track, moving control over health care and coverage decisions to doctors, patients, and families.

Congress has an extremely difficult task, with innumerable hurdles in repealing and replacing ObamaCare, but the train is nearly ready for boarding and the month-long journey is about to begin.

The media have been stuck writing the same story for months, saying Republicans have no ideas for replacing ObamaCare. Even former House Speaker John Boehner joined the chorus.

They are wrong and clearly haven’t been paying close enough attention.

Beginning in late 2015, under the direction of Speaker Paul Ryan, relevant House committee chairs devoted most of 2016 to building consensus around a replacement plan, resulting in the “Better Way” proposal Speaker Ryan released in June.  Staff then turned to the task of drafting legislation. Many senators and conservative think tanks also developed comprehensive reform plans.  All had significant input into the legislation that now is being finalized.

Leaders consulted outside groups in countless meetings to absorb the lessons of ObamaCare’s failures and then chart a new course that gets the incentives right and builds on the strengths of competition and consumer choice.

Now they are consulting with President Trump and working closely with his White House aides to make sure his repeal-and-replace message from the 2016 campaign and policy goals are integrated into the bill they are developing. Senators are also having major input on the shape of the bill.

There is no possible way that the Congress could be on the verge of passing major repeal and replace legislation if all of this hard work had not been going on since late 2015.

The hardest job of all is hammering out the legislative details. There are differences in how to provide support for people who need help in purchasing health insurance—tax deductions, credits that are refundable, advanceable—how long transition coverage should last, etc.  But on the basic structure of the plan, there is much more agreement than disagreement.  A very big question remaining is how the Congressional Budget Offices will score the plan.

Undoubtedly, the job this time is harder than the Obama forces faced, largely because they now have to first deal with the wreckage of ObamaCare.  But it’s also easier because they believe in developing incentives that empower consumers, not trying to micromanage markets.

Conservatives have seen from the failed experiment with ObamaCare the hubris of believing politicians can write enough laws and regulations to control one-sixth of the American economy. We have ample proof that Does. Not. Work!

The Congress and the White House say they are very close to unveiling their Repeal WITH Replace plan. They will create a lifeboat and a bridge. They can’t open themselves to the charge that millions of people who are on Obamacare now will lose their coverage—again! So they need a lifeboat to make sure those on ObamaCare now continue coverage in a transition.

At the same time, they need to build a bridge to new coverage—market-friendly reform that puts doctors and patients back in charge of their medical decisions, enhances HSAs, returns authority to states to oversee their health-insurance markets, and provides revenues to help those who have difficulty purchasing or affording health insurance. They also will begin the desperately needed process of modernizing the Medicaid program to provide access to care instead of an often-useless Medicaid card.

It will not be perfect and not everyone will agree with everything in the plan.  And it has to navigate a complex budgetary reconciliation process to get through the Senate to keep Sen. Schumer from blocking repeal and replace with a filibuster.

But they can get this done.  And if they succeed, they will have plenty of time to continue to make improvements. Passing this first legislation is the foundation for everything that will come after through follow-on bills and executive actions.  Staffers close to the development of the legislation say this will be the foundation for the most transformational health reform since Medicare and Medicaid were enacted.

However, if the replace effort fails to get a majority vote in both houses, ObamaCare will fail, and Republicans will be blamed.  After four elections where voters made it clear how much they dislike ObamaCare, Democrats want nothing more than to get this monstrosity off their political backs and blame Republicans, as President Trump has warned.

My colleague at the Galen Institute, Doug Badger, told The Wall Street Journal just that in a recent interview: “You’re a Republican, you’ve been running to repeal Obamacare, they put a repeal bill in front of you… Are you going to be the Republican senator who prevents Obamacare repeal from being sent to a Republican president who is willing to sign it?”

There are members who are strongly criticizing the effort, saying they will try to defeat it because it’s not perfect.

That is basically what happened with Social Security reform in 2005. After his re-election, former President George W. Bush put this issue at the top of his agenda, promising young people and growing families the huge benefit of creating private retirement accounts to save for their future instead of simply turning over a lifetime of payroll taxes to the federal government.

But conservatives couldn’t agree on the details of the private accounts and dragged out negotiations. Then Hurricane Katrina hit, and Social Security Reform was history.

This is the window for passage of Repeal and Replace.  A huge legislative agenda is backed up behind it. This is the chance for Congress to show the American people members hear them and that they can govern.

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