The Right Way to Repeal Obamacare
By SEN. TED CRUZ
“Is Obamacare Republicans’ Waterloo?” That was the question a reporter posed a couple weeks ago. It’s the narrative increasingly being pushed by the media, and starting to become conventional wisdom in Washington.
My response? What the press doesn’t understand is that Obamacare, in practice, has proven to be a disaster, and it’s hurting millions of people. We’ve had three elections that focused on Obamacare repeal, 2010, 2014 and 2016. All three were massive victories for Republicans. If that’s Waterloo, we could use a few more of them.
So, how do we go forward? Here are two overarching principles, three concrete steps and six areas of consensus to guide us.
Two overarching principles
First principle: Honor our promise. When you spend six years promising, “If only we get elected, we’ll repeal Obamacare,” you cannot renege on that promise. Failure is not an option. Breaking our word would be catastrophe. The voters would, quite rightly, never again trust Republicans to deliver on anything.
The second principle is don’t make it worse. The Pottery Barn rule applies: If you break it, you own it. Democrats broke health care: Since Obamacare passed, millions of people have had their plans canceled; average family premiums on employer-sponsored plans have risen by about $5,000; and average family deductibles on the individual market have also risen $5,000. Consumers are paying more for less, and that’s hurting a lot of families. Republicans can’t make it worse; instead, we’ve got to fix the problem.
Three concrete steps
First, begin with the 2015 repeal language. Senate Democrats have made clear that they will filibuster any attempts to repeal Obamacare, so the only way to get it done is to use a procedural vehicle that can’t be filibustered. Budget reconciliation—a special procedure that by statute requires only 51 votes to clear the Senate—fits the bill. The hurdle is that budget reconciliation is governed by complicated procedural rules; only legislation that is budgetary in nature is permissible. And it is the Senate parliamentarian who typically decides whether a given proposal is allowed on reconciliation.
In 2015, Congress passed language on reconciliation repealing most of Obamacare. Virtually every Republican in Congress voted for that language, and the parliamentarian has already ruled it as permissible. We should begin with that previously approved repeal language as the baseline.
Second, repeal the insurance regulations as well. In 2015, these coverage mandates of Obamacare were excluded from the repeal language. The parliamentarian never ruled on whether including them would be permissible on reconciliation. But we’ve got to repeal those mandates. Why? The single biggest factor driving popular dissatisfaction with Obamacare is skyrocketing premiums. And the insurance mandates are the biggest factor driving those premiums. If we “repeal” Obamacare, and leave the insurance mandates in place, the premiums paid by families will remain sky-high. And that’s unacceptable—voters would rightly deem repeal a farce if we don’t actually drive premiums down to where they’re affordable again.
Can we get the mandates repealed on reconciliation? The answer is yes: The mandates are driving up federal expenditures by billions, and so should properly be deemed budgetary in nature. But if the parliamentarian disagrees, the vice president has the statutory and constitutional authority (as does the Senate majority) to rule to the contrary. And that’s exactly what should happen, if necessary.
(It’s not enough to say that some of the mandates can be suspended by the Trump administration. As Barack Obama has discovered, executive action is temporary. The next Democratic president, if able, would surely reimpose the mandates. We cannot allow that to happen.)
Third, we should focus on areas of consensus among Republicans. Don’t try to replace one 2,000-page monstrosity with another. Instead, adopt common-sense specific reforms that will increase competition, drive down costs, expand choices and put patients back in charge of their health care.
Six areas of consensus
First, we should allow consumers to purchase insurance across state lines. This would create a true 50-state marketplace, driving down costs for everyone. If California wants to mandate that every California insurance company must offer only top-of-the-line comprehensive coverage—driving up premium costs by thousands of dollars—then California consumers should also be able to buy insurance licensed in other states, without the mandates.
If you want more access to health insurance, cost is key. If they so desire, consumers should be able to purchase low-cost catastrophic insurance on a nationwide market.
Second, we should expand health savings accounts so that consumers can save on a tax-advantaged basis for more ordinary health insurance expenses.
Third, we should change the tax laws to make health insurance portable, so that if you lose you job you don’t lose your health insurance. You don’t lose your car insurance or life insurance or house insurance if you lose your job; you shouldn’t lose your health insurance either. And that would go a long way to addressing the problem of pre-existing conditions, since much of that problem stems from people losing their jobs and then not being able to get new coverage on the individual market.
Fourth, we should protect continuous coverage. If you have coverage, and you get sick or injured, your health insurance company shouldn’t be able to cancel your policy or jack up your premiums. That’s the whole point of health insurance.
Fifth, we should allow small businesses to pool together in association plans to get better rates for their employees. And we should allow states to create high-risk pools or pursue other innovative solutions to insure that the most vulnerable among us have access to affordable health care.
Sixth, we should block grant Medicaid to the states. Right now, Medicaid works terribly: very few doctors, long waiting lists and markedly worse health outcomes than for those on private insurance. Much of that is driven by one-size-fits-all federal rules, forced on every state. Instead, we should allow states to innovate with creative solutions to help produce far better health results.
Those six ideas enjoy virtual unanimity among Republicans who now control both Congress and the White House. They bring all of us together. They don’t replace one massive federal entitlement that isn’t working with another massive federal program with the same failings.
We should implement all six on reconciliation. We can do this, and produce real results. The test for success should be simple: Did health care become more affordable? Do consumers have more choices? Do patients have more control over their families’ health care?
If yes, we will have succeeded. We will have honored our promise to the American people.