More from my interview of Louisiana governor Bobby Jindal Wednesday, discussing his proposal to repeal and replace Obamacare:
Geraghty: How does your proposal differ from the repeal-and-replace proposal from the Republican Study Committee, or other plans and ideas from Republicans on Capitol Hill?
Jindal: There absolutely are proven concepts that are common in a lot of different conservative plans — lawsuit reform and other elements like that I think are very attractive. But I do think there are some things that are unique about this plan.
One, it’s comprehensive; it does include premium support in Medicare. It does include the global grants for Medicaid. It does include state reforms on certificates of need and provider scope to provide more supply-side competition. It includes the state grants — $100 billion to states — so there’s a strong federalism component.
With the tax equity, by doing the standard deduction, it drives more efficiency in health care.
I also think it’s a good thing that there are conservatives and Republicans talking about health care. I think there needs to be more of that. Unlike the Left, we don’t have to all march behind Obamacare or behind one plan. I think there’s a good thing there’s a competition and a bunch of different ideas. As somebody who spent much of my career in health-care policy, I hope more Republicans will talk about health-care policy.
We intend all of AmericaNext’s products to be “open source code” — we hope folks use it, there’s no pride of authorship. They can cut and paste it, they can borrow it, adapt it, put it in their plan. This is advancing the conservative debate. The president likes to say that there is no alternative to replace Obamacare with — he needs to stop saying that! The reality is there is an alternative. He can debate us on the merits, but there is a substantive, specific alternative.
Compared to Obamacare’s baseline, ours reduces premiums by $5,000. His actually took the previous marketplace and increased it by $2,100 for a family. The reality is, our plan, I believe, actually delivers what he promised back in 2008 better than his plan does. In 2008, he talked about the need to reduce health-care costs, he opposed the mandate when Senator Clinton proposed it, and since ‘08 he’s talked about the need to keep your plan and your doctor. His plan doesn’t do those things. Our plan actually does.
Geraghty: There are some elements of Obamacare that even the most staunch conservatives are wary about repealing entirely – lifetime limits, pre-existing conditions, or things like that. If there are some parts we don’t need to take away, do we really need to repeal the whole thing? Can you do partial repeal?
Jindal: No, we’ve got to repeal it. Take it out by its roots. The whole thing needs to go. This plan gets rid of the tax increases, Medicare cuts, and doesn’t replace those tax increases or Medicare cuts. When it comes to the insurance-market reforms, we give $100 billion to the states with very few strings, except we do tell them that they’ve got to guarantee they’ll provide coverage for those with pre-existing conditions. You can do that with high-risk pools, reinsurance, there are a lot of ways to do that. But secondly, we also tell them, you’ve got to use these dollars to lower premiums in their marketplace.
I think that one of the mistakes that the Left makes is that it doesn’t trust people. It doesn’t trust local government. The reality is, that if there are good insurance reforms, they’ll be adopted at the state level.
In Louisiana, it is state law, for example, that kids up to 24 can be carried on their parents’ plans. Not every state agrees with that. But the point is that states are in a better position to make these decisions.
[In 2011 Louisiana’s legislature passed, and Jindal signed into law, a bill that allows children to remain on their parents’ plans until age 21, or age 24 if the child is a full-time student, or continuously if the child is disabled.]
A lot of insurance companies said, before the Supreme Court case, that even if Obamacare were struck down, they weren’t going backwards on those provisions anyway. The Left doesn’t want individual consumers to select their own health-care plans; they don’t want states to make these decisions. I think one of the big mistakes of Obamacare is this one-size fits all benefits approach, regulatory approach from the federal government telling us how we buy health insurance.
One of the things that the cross-state sale of insurance will do under our plan is that as states consider these mandates, benefits, or other restrictions, it will force states to be more cognizant of what it does to the premiums. Now you’ll actually have real competition. The Founding Fathers intended for the states to be laboratories of experimentation. Let’s let that work.
Geraghty: So you’re fine with children staying on their parents’ plans until age 24 or 26?
Jindal: I’d say I’m fine with states being able to make that decision. I don’t think the federal government should dictate that decision. Now, different states can make different decisions. What’s happening right now is that states have been shielded from the consequences of their decisions. There isn’t that competitive pressure to reduce costs, reduce mandates or even examine if the costs outweigh the benefits.
If you adopted these reforms, and you empowered individuals to buy their own health care and made it more affordable, it might cause a lot of states to reexamine whether they needed these restrictions and regulations.
Geraghty: President Obama is going to be sitting in the Oval Office until January 2017. As far as he’s concerned, Obamacare is working fine. Occasionally he’ll say he’s willing to listen to ideas to reform Obamacare, but he never gets all that specific about what he wants to reform. Is it realistic to think that anything in your plan can end up on his desk, or that any of it can be signed into law by President Obama? Or is it really just setting up a blueprint for what Republicans could do in 2017?
Jindal: One, I do think you’ve got to win the debate first. We’ve got to have this debate. We have to go out and show that there is a good alternative. But absolutely there are things that can be done. We don’t need to forget that this president forced this bill through with parliamentary maneuvers and on a party-line vote. There’s a lot that can be done. The reality is you’re seeing more and more Democrats running away from this law, especially those facing their own reelections.
I think it’s a mistake to assume Democrats will never vote for repeal, and that Democrats will never vote for different provisions. I think the reality is they’re about to pay a pretty big political price for supporting this bill. You’re going to see more and more Democrats open to this — as they see the bill isn’t doing what they promised it was going to do.
It’s odd to have a president say it’s a good thing to have over two million fewer Americans in the work force. It’s odd for a president to say, “You know what, you’re not going to be able to keep your doctor. Maybe I shouldn’t have said you were going to keep your health care plan.” It’s odd when the president said, very specifically, not vaguely, “I’m going to cut your premiums $2,500″ and the CBO says they’re going to go up $2,100.
I wouldn’t underestimate how many Democrats will start running from this law and looking for opportunities to repeal and replace. I wouldn’t want to negotiate with ourselves and say, “No, we can’t get this done.” But even before we pass this law, we’ve got to win the debate. We’ve got to persuade folks and show them there’s a better way.
Geraghty: Periodically, conservatives will say we really have to separate the employer from health insurance. That way it will be more portable, and easier for people to take their health insurance from one job to another job. It seems that one of the experiences of Obamacare is that people don’t always like having choices, and that in fact a lot of people don’t like to think about health insurance any more than they have to. Your plan pushes in the direction of separating health insurance from employment. Are Republicans ready for a backlash on that aspect?
Jindal: My takeaway from Obamacare is that people do like choices, but they don’t like to be forced to do things they don’t want to do. We do ease away from that job lock by giving people the ability to have a portable deduction. We also do through association plans that can be sold across state lines with ERISA protections to give them more choices. We do make it easier for people to buy their health care through the individual and other marketplaces.
We’re very explicit about this: This is going to be a voluntary and gradual transition. This is not going to be an overnight, dramatic, and forced transition from employer-provided health care. The reality is, folks can continue to get their health care through their employers. This is one of the benefits of making it a standard deduction, as opposed to some of the other alternatives that are out there. You can still get your health care through your employer, and most people probably still will, in the short term. That doesn’t change overnight. But what you have is a gradual transition where now if people change jobs, they can go to the individual market without exhausting COBRA. If they want to buy through their churches or unions or their social membership multi-state clubs, they can do that and get those ERISA protections.
It’ll be easier to buy [Health Savings Accounts], it’s be easier to bring those tax-advantaged accounts with you from place to place.
It’s also going to be easier for employers to provide health care – because now they can contribute to a wellness account on a tax-advantaged basis or an HSA with varying deductibles, or they can allow you to use your savings in your HSA to pay your premiums, which they couldn’t do before.
I think it actually makes it easier for employers who want to continue to provide the health care, but it also makes it easier for folks that are changing jobs or changing states that don’t want to be job-locked.
You may have seen that new study out today from larger employers talking about the thousands of dollars per employee that Obamacare is going to cost them over the next several years. So it’s not just small employers, but big employers are waking up to these costs, too.
Geraghty: I notice you used the term “job lock” twice. I presume you mean staying in a job because you need the health insurance. But I presume you recall Nancy Pelosi lamenting how terrible it was that people getting locked into jobs . . .
Jindal: I think she was talking about them going and becoming artists or whatever and not working. What I’m saying is that when you change jobs, or move jobs, you should be able to take your health care with you.
Geraghty: Who advised you on this?
Jindal: Chris [Jacobs, policy director for America Next]. A lot of people. We’ve talked with a number of folks — conservative governors and lawmakers and health-care-policy folks. This is something we’ve been working on for a while. But it also comes from my career of thinking about and writing health-care policy. Premium support, for example, goes back to my year on the Medicare commission in the 1990s. I like to remind folks, we’re the ones who came up with the idea of applying premium support to Medicare, and the [center-left think tank Democratic Leadership Council] endorsed it that year. Now the Left likes to call it this radical, fringe idea, but the reality is that this has been something that has been around for several years, and the [American Medical Association], the Mayo Clinic, the Wall Street Journal — several mainstream folks endorsed this concept way back when.
The global grant on Medicaid reform is something I’ve been talking about with governors for quite some time. It’s not just Republican governors, Democratic governors are very frustrated with what they see coming out of [the Center Medicaid Services] and HHS in D.C. When you look at the market reforms, I’ve been talking to folks in the industry, patient-advocacy groups, and asking, “All right, if we were do these things differently, how should we do these things?”