5. Defund the CMS Innovation Center Among many other things, Obamacare created a permanent recurring “mandatory appropriation” of $10 billion annually for what is called the Innovation Center in the Centers for Medicare and Medicaid Services (CMS). This funding pays for the agency’s federal staff as well as the costs of running tests of new ideas in the Medicare and Medicaid program. The agency’s mandate is so broad and ill-defined that just about anything could be justified. Moreover, giving the agency permanent funding like this runs against experience of what constitutes good budgeting practices. The House should terminate the funding and save what’s left of the original $10 billion appropriation.
6. Break the Exchange Monopoly Obamacare shifts immense power to the federal government by moving millions of Americans into a federally sponsored system of insurance — the exchanges. Once citizens purchase insurance through the exchanges, the government can steadily exert more and more control over the plans and options available to them. The law’s power stems from the requirement that the new entitlement to subsidies for health insurance — called “premium credits” — can be used only in the Obamacare exchanges. The House GOP should challenge this requirement and propose giving Americans the right to use the premium credits outside the confines of Obamacare. For instance, citizens should be allowed to deposit the credits in existing health savings accounts without any requirements for changes.
7. Suspend Insurance Rules When Premium Increases Exceed X percent Obamacare’s new insurance rules are expected to force large premium spikes on many millions of existing insurance enrollees. This will be especially true for younger consumers who could see premium increases of 30, 40, or 50 percent in some cases. The prospect of some groups paying such high premiums will create an opportunity for the House GOP to highlight the unfairness and irrationality of Obamacare. One way to bring attention to the matter would be to suspend the Obamacare insurance rules in circumstances in which they cause such a premium spike. Consumers would be allowed to stay with their current insurance under the old rules until the premium increase is no more than an acceptable percentage (such as 8 percent).
8. Statutory Option for State Medicaid Flexibility The Obama administration is desperate to get states to agree to expand their Medicaid programs as envisioned in the Patient Protection and Affordable Care Act. (The Supreme Court struck down the law’s requirement that states implement the expansion or face penalties; the expansion is now a state option.) Without state cooperation in this regard, the law will never come close to its coverage goals. But many governors are rightly reluctant to expand a program badly in need of fundamental reform. Republican governors should use their leverage and work with the House GOP to pass a statutory reform of Medicaid. In short, states should be given sweeping flexibility to manage Medicaid within a fixed and predictable budget.
9. ACO/Medicare Supplementary Insurance Reform Obamacare seeks to herd seniors into government-sanctioned HMOs — called Accountable Care Organizations (ACOs). Amazingly, the administration wants to do this without even advising most seniors that they have been placed into a managed-care plan, or without allowing them to share in the cost-savings that is supposedly the point of the effort. The House GOP should highlight the hypocrisy of such paternalism and give seniors genuine choices. They could choose to enroll in an ACO if they wish, and if they do enroll, they would get to share in any savings. This change could be coupled with a change to the secondary insurance rules allowing full coverage of all Medicare cost-sharing only for beneficiaries enrolled in cost-reducing ACOs.
10. Repeal the Medical-Device Tax Obamacare is full of taxes — $1 trillion of them over a decade — and it’s important for the House to continue to highlight the damaging effects they will have on middle-class families. A very good example is the new tax on the medical-device industry that is already slowing research and innovation and forcing companies to cut back the size of their workforces. This is truly a “job killing” tax — and a straight repeal vote is sure to draw many Democrats who agree.
Full repeal of Obamacare is not going to happen in the near term, but that does not mean that the struggle over the future of American health care is over. It is not. This issue is far too important to the nation’s health and future prosperity to walk away from. There are still many things the House GOP can do to push health-care policy in a new direction short of full repeal. A good place to start would be to put the ten ideas described here into bill form, and then pass them.
— James C. Capretta is a visiting fellow at the American Enterprise Institute and a senior fellow at the Ethics and Public Policy Center.