Politics & Policy

Can Obamacare Be Undone?

The reality of repeal.

Two years ago, President Barack Obama signed his landmark health-care legislation into law. We’re still learning what’s in it, and approaching an election that will result in our digging deeper into a bureaucratic takeover of our most intimate, life-and-death decisions. Or we’ll repeal it. Is there life after Obamacare?

JEFFREY ANDERSON

There is no question that Obamacare can be undone. The American people want it undone. The only question is whether the Republican party, and the eventual Republican nominee whoever that may be, will show the necessary leadership and resolve to bring about the desired result. If Republicans want to repeal Obamacare as badly as President Obama wanted to pass it, Obamacare will be repealed.

But that leadership must begin in the campaign. Too many Republicans have been duped into thinking the 2010 election somehow wasn’t about Obamacare — as if they could otherwise have gained 63 House seats (more than either party had gained since before Obama was born) when exit polling showed that more voters blamed President Bush for the economy than President Obama. Too many Republicans likewise buy into the narrative that the coming election will be about the economy. Obama would like that, as would the press corps. But Republicans should make it clear that, while the economy is a crucial issue in this election, the central issue is Obamacare. 

If Obama gets sent packing in an election that’s largely focused on Obamacare, Democrats will lose their stomach for the fight. There will be plenty of votes to repeal (the vast majority of) Obamacare via reconciliation — the means the Democrats used to pass it — if not via the normal legislative process. But if Republicans allow Obama and the press corps to focus the election on the economy, they are less likely to win — and less likely to bring about repeal even if they do.

— Jeffrey Anderson is a senior fellow at the Pacific Research Institute.

MICHAEL CANNON

Close your eyes and imagine the Supremes have overturned all of Obamacare. Let that sink in. Now snap out of it, sunshine. We can’t count on that. We must exploit Obamacare’s every vulnerability.

The biggest is its health-insurance exchanges. Even Maine refuses to create one. We must convince every state to follow suit. HHS hasn’t the money to create them if states balk. Even if it did, it has no legal authority to offer tax credits and subsidies in federal exchanges. Either way, Obamacare collapses.

Once Obamacare dies, we must be careful not to resurrect it. Specifically . . . 

Don’t re-create health-insurance tax credits. They carry the same baggage as Obamacare’s and expose you to charges of hypocrisy. Expanding health savings accounts is the better option.

Don’t throw federal dollars at high-risk pools. Let states decide how to subsidize people with preexisting conditions. Congress should roll such funds into Paul Ryan’s Medicaid block grants.

Don’t permit a “public option” in Medicare. If you can’t get rid of it in the first round of Medicare reform, do it the following year.

Do self-educate about health care the way the Left has, lest they recapture the upper hand.

— Michael F. Cannon is director of health-policy studies at the Cato Institute.

JOHN GOODMAN

There are numerous structural flaws in the Patient Protection and Affordable Care Act. Each is so potentially damaging that Congress will have to resort to major corrective action to address it in the absence of repeal. Here’s a revenue-neutral approach to begin the necessary corrections: Delay the scheduled cuts in Medicare spending by five years and pay for that expense by delaying the (2014) start date of Obamacare by two years.

This makes sense: Almost no state is ready for the scheduled 2014 opening of the state health-insurance exchanges. A majority have not even tried to get ready. In addition, a reason to delay the draconian cuts in Medicare physician fees is that all of the pilot programs designed to achieve efficiencies are producing negative or lackluster results — forcing Medicare to fall back on a requirement to reduce doctor and hospital fees to such an extent that access to care for the elderly and disabled will be severely impaired. 

Without a mandate, the insurance exchanges would collapse under the weight of people gaming the system. However, a weakly enforced mandate is like no mandate at all. If the Supreme Court strikes down the individual mandate, it may be a blessing in disguise for the administration — allowing both parties the opportunity to get back to work and ultimately replace Obamacare with something that will work.

— John C. Goodman is president of the National Center for Policy Analysis.

KRISTAN HAWKINS

For the survival of this great country, the freedoms we hold dear, and our individual liberties, it is imperative that Obamacare be repealed or struck down by the Supreme Court. The law gives government unprecedented control over our lives, forcing us to buy products we may not want and to pay for abortion-inducing drugs. No government should be able to force its people to choose between violating their consciences and paying steep penalties. Obamacare must go.

If the Court does not strike down the law and a Republican wins the White House, his first priority must be to take whatever actions necessary to repeal this law. It is disheartening to think of any other outcome.

— Kristan Hawkins is executive director of Students for Life of America.

CARRIE LUKAS

Obamacare isn’t just bad policy; it’s also a lost opportunity to advance positive health-care reforms. This is a critical point for the public to understand as the Supreme Court considers Obamacare’s constitutionality, and as we begin a presidential election in which the future of the health-care system will be a central issue.

The debate isn’t between Obamacare and the status quo. No one thinks our current system is optimal. It’s inefficient and costly, it encourages the over-consumption of care, and it unfairly disadvantages those who don’t receive insurance through their employer. The question is which direction we should go. Should we follow Obamacare’s path of greater government control or find a different way to encourage greater efficiency, control costs, and improve outcomes?

If Obamacare is struck down or repealed, policymakers should move quickly to reform our health-care system in a way that returns the control of resources to individuals and creates a more competitive health-insurance marketplace. For starters, they should equalize the tax treatment of individual and employer-sponsored health insurance.

But to really reform our medical system, policymakers will have to tackle Medicare, because it shapes the medical system as a whole. Congressman Paul Ryan and Senator Ron Wyden have laid out a blueprint for reforming Medicare that would be a giant leap in the right direction.

Let’s hope that Obamacare is quickly laid to rest so we can begin the important national conversation about these next steps.

— Carrie Lukas is the managing director of the Independent Women’s Forum.

THOMAS P. MILLER

Repealing Obamacare is necessary to preserve individual liberty, maintain limited government, improve health care, and restore economic growth. Prospects for doing so hinge on a half-dozen key battle fronts, and success thereafter hinges on several, if not all, of them.

Legal: The Supreme Court could overturn the entire Affordable Care Act later this year as unconstitutional. That’s possible, but not likely. But even a partial victory — simply nullifying the individual mandate — would unravel the political glue that holds this unwieldy and unworkable law together. Congress would have to fix or replace whatever remained.

Political: It will take a new president to sign any law to repeal Obamacare, let alone replace it with better health policy. This November’s elections also will determine whether Obamacare opponents regain working control of the Senate.

Legislative: Fully repealing the entire health-care law would require 60 votes in the Senate. But a budget-reconciliation measure could remove its essential features (“debone it”) with only a narrow majority in both houses of Congress.

Administrative: Obamacare’s complex wiring for implementation could short-circuit on its own and threaten to crash most of the health-care system. Many states are refusing to submit to federal command and control. Imaginary structures and lab experiments (health exchanges, real-time income information, Washington-created “innovations”) won’t be ready for prime time. By necessity, we will have to build something else that is effective, cheaper, and sustainable.

More appealing alternatives: The time to fill in a “replace” agenda is long overdue. Good ideas exist, but they need to move from the imaginary to the practical stage and hang together as a whole.

Timing: Repeal-and-replace needs to happen before new subsidy dollars under Obamacare start flowing to millions of Americans in 2014. Our future health and prosperity can’t afford further doses of toxic medicine for another four years.

— Thomas P. Miller is resident fellow at the American Enterprise Institute.

NIKOLAS T. NIKAS & DORINDA C. BORDLEE

The Obama administration itself is making it easier with each new ream of regulations to undo Obamacare. The HHS employer mandate and the administration’s latest sham proposals for “religious accommodation” show that they are doubling down on government entanglement in church business. So won’t Americans be surprised when it’s not “just” the Catholic Church’s rights of conscience but their own consciences being violated as the 2014 individual mandate pulls them unwillingly into the abortion-premium mandate — without a right to decline paying directly into a designated abortion fund. Our amicus brief filed with the Supreme Court brings attention to that little-known land mine. The bottom line is that even if Obamacare survives a Commerce Clause challenge, the administration will soon be introduced in court to a less obscure provision known as the Free Exercise Clause of the First Amendment.

— Nikolas T. Nikas and Dorinda C. Bordlee are president and vice president of the Bioethics Defense Fund.

NINA OWCHARENKO

Two years later, Obamacare is as unpopular as ever. A recent Rasmussen poll shows 56 percent of likely voters favor repeal, with 46 percent strongly in favor of jettisoning the law. Opposition to the law is nothing new. Even at the point of enactment, Rasmussen found 55 percent of voters favored repeal.

The vast majority of the health-care law does not take effect until 2014. Still, the meager assortment of provisions currently in effect suggests a bleak future, offering more reasons for full repeal. The record thus far shows that Obamacare policies have fallen short of expectation and are counterproductive and unworkable. The CBO’s recently updated score of the law reminds everyone that its true cost is far greater than originally claimed, and that the law fails to uphold the president’s own promises.

The upcoming Supreme Court case is yet another indication that Obamacare is far from settled law. Therefore, unless the Supreme Court strikes the whole law down, it is Congress’s duty to finish the job. Only after Congress fully repeals Obamacare can it begin to set course on an alternative path for health-care reform. What’s needed is a patient-centered, market-based approach that is fiscally responsible, improves access, and allows Americans to choose the health-care coverage that fits their individual needs. Such a plan is outlined in Heritage’s Saving the American Dream. But the first step is repeal of Obamacare.

— Nina Owcharenko is director of health-policy studies at the Heritage Foundation.

SALLY PIPES

The question is not whether Obamacare can be undone but when. It must be undone. Repeal and replace is the only solution for bringing about affordable, accessible, quality care for all Americans. As Obamacare celebrates its second anniversary today, it is still unpopular with Americans — 56 percent are still in favor of repeal. This is not good news for the president and probably one of the main reasons that he devoted only 44 words to health care in this year’s State of the Union address and that he is not going to give an address celebrating the health-care law’s anniversary from the Rose Garden.

The Supreme Court begins a record three days of hearings on Monday. The Court will be considering the constitutionality of the individual mandate, the issue of severability, the federal government’s forcing states to expand their Medicaid programs, and the question of whether the mandate is a tax.

Regardless of how the court rules in June, it is essential that repeal-and-replace be the prime goal. The Congressional Budget Office released a report last week showing that the cost of Obamacare is going to reach $1.76 trillion over the decade from 2012 to 2022. This is a far cry from the original estimate of $940 billion over ten years. The president’s goal of bending the cost curve down is unattainable. The CBO also forecast last week that up to 20 million Americans will probably lose their employer-based health coverage and be forced into state-based exchanges. So much for President Obama’s oft-repeated statement “If you like your health insurance and you like your doctor, nothing will change.” Americans know that things are changing and they do not like the prospects for their future health care.

In January 2011, the House voted to repeal the law, but the bill did not make it through the Senate. The House has also voted to repeal the CLASS Act and IPAB, but neither will likely be taken up by the Senate. While piecemeal fixes are fine, we must not take our eye off the real goal: repeal and replacement of the entire law. And there is still time to reverse course. In early 2013, our congressional leaders can repeal Obamacare and replace it with market-based reforms that expand access to coverage, provide quality care, and lower costs.

Most of the cost drivers in the legislation do not go into effect until 2014. If Obamacare is not repealed before that date, it will be very difficult to reverse course. You just need to look at the experience of the government-run systems in Canada and Britain. Politicians know that changes are needed if they are going to eliminate long waiting lists and rationed care. But the path is not an easy one. Let’s hope we make the changes before it is too late.

— Sally C. Pipes is president and CEO of the Pacific Research Institute. Her latest book is The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare.

MICHAEL RAMLET

Regardless of the Supreme Court decision, the Affordable Care Act will ultimately be undone, because it’s bad economics, bad budget policy, and bad health policy.

And it will be undone by the nation’s governors as Congress remains stalemated.

If the Supreme Court strikes down the law, the nation’s Republican governors will be the first to release a comprehensive replacement plan (Replacement Principles). If the law stands, it is the governors who are in the best position to delay, obstruct, and pursue alternative health-care reforms.

With the ACA already shifting $12 billion in hidden regulatory costs to states and the private sector, it will be more than just Republican Governors who will be compelled to undo the ACA. By 2019, governors of all political stripes will be required to slash education, transportation, and other state budget priorities to afford the federal government’s coercive Medicaid expansion.

Thankfully, America could not ask for better leadership in undoing the failed ACA. Instead of a one-size-fits-all federal approach, we can give the job to the governors who are best able to make decisions about the design of their states’ health-care systems based on the needs, culture, and values of their citizens.

— Michael Ramlet is director of health policy at the American Action Forum.

AVIK ROY

The short answer is, yes, Obamacare can be undone, if Republicans maintain their House majority in November, elect a Republican president, and get 50 Republican seats in the Senate. Obamacare can be repealed using the reconciliation process, because a simple one- or two-page repeal bill would have to be considered “germane” to the budget.

Many conservatives believe that the Supreme Court will do the heavy lifting for them, by striking down the law. But this is highly improbable. At most, the Court is likely to overturn the individual mandate and two closely related provisions: “guaranteed issue,” which forces insurers to take on patients regardless of whether or not they are already sick (preexisting conditions); and “community rating,” which forces young people to pay more for insurance in order to make insurance cheaper for the middle-aged.

The Supremes are likely to leave the rest of the law — its massive expansion of Medicaid; its costly and unwise insurance regulations; even its federal takeover of student loans — intact.

Many conservatives are grumbling about the quality of the GOP presidential field. What we do know, however, is that any of these nominees will repeal Obamacare. And if we don’t repeal Obamacare, it will be extremely difficult, if not impossible, to bring our federal deficit under control. Hence, no matter who ends up being the nominee, we’ve got to stop grumbling and do the hard work to get that man elected.

— Avik Roy is a senior fellow at the Manhattan Institute and author of The Apothecary, a Forbes.com blog on health-care and entitlement reform. You can follow him on Twitter at @aviksaroy.

TEVI TROY

Two years ago, the Democrats passed the Obama health-care law to great fanfare and assumed that it would be the key to a new era of Democratic electoral dominance. What we have seen over the last two years is that, unlike previous expansions of the welfare state, this law has not been absorbed into the body politic. Instead, because of its expense, intrusiveness, and the partisan way in which it was passed, it is being resisted, and on a number of fronts. On the political front, every one of the Republican candidates has pledged to repeal the law. On the legislative front, Republicans made big gains in Congress in 2010 because of opposition to the new law, and the House has already passed a bill to repeal it. And as we will see next week at the Supreme Court, the legal challenge to the health law is a serious and substantive one, despite Democratic dismissiveness of it in its early stages.

All of these very real challenges to the law have put its backers on the defensive, and have generated uncertainty about the its prospects within the health industry and in the states that are supposed to implement part of it. All of this does not mean that we can count on the law’s being overturned. What it does mean is that conservatives have made great strides in moving towards elimination of the law, but that hard work remains to be done.

— Tevi Troy is a senior fellow at the Hudson Institute and former deputy secretary of the U.S. Department of Health and Human Services.

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