Senators Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.) have crafted a health-care deal that demonstrates why alleged fixes to Obamacare traveling under the banner of bipartisanship are such a non-starter.
The deal is a response to President Trump’s recent executive actions. One of these ended “cost-sharing reduction” payments to health insurers, which covered the cost of insurer discounts to lower-income consumers in the health-care marketplace. Congress never actually appropriated the funds for the payments, and the executive branch had been illegally sending insurers the money until Trump rightly decided to stop.
That decision was immediately met with cries that Trump had trampled on the health-care system and demands for legislative action to “stabilize” the marketplace. Liberals maintain that the consequences of congressional inaction would be dire. But while the Congressional Budget Office estimated that premiums would rise on average in the individual market, Obamacare subsidies would shield most consumers from having to pay the increased prices — and some consumers would pay less.
In other words, the Alexander-Murray deal is a solution to an overblown problem. The deal is being sold as a short-term fix, appropriating funds through 2019. But in all likelihood it would wind up being permanent, like most government spending, with Congress simply renewing it when its time runs out.
In exchange for appropriating the Obamacare funds, Republicans would get . . . nothing much. No Hyde Amendment–type protections are included on the CSR subsidies, for instance, meaning the funds could go to insurance plans that cover abortions.
Alexander-Murray barely reforms the process by which states can obtain 1332 waivers, which allow them to develop their own parameters for individual insurance coverage. The ACA currently requires state proposals to be “as affordable as” Obamacare coverage, meaning that states must design coverage systems that mimic the policy regime of Obamacare. This deal would change the requirement to “comparable affordability,” a merely semantic change that would preserve the essence of the status quo.
A deal that funded cost-sharing-reduction payments might be worth having if it allowed states to waive the individual mandate and secured meaningful deregulation of Obamacare. Alexander-Murray does neither, and it’s unlikely that Democrats, increasingly the party of single-payer, would agree to any substantial reforms.
With President Trump opposed after foolishly encouraging Lamar Alexander to go down this road, and with Speaker Paul Ryan and other key Republicans against it, the agreement doesn’t seem likely to do go anywhere. Republicans should continue to focus their energies on finding any reforms that can get 51 votes in the Senate and not fall into the trap of propping up the law they have, rightly, pledged to repeal.
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