The Corner

Tonight Is a Really Big Moment for the Repeal-and-Replace Effort

From the Tuesday edition of the Morning Jolt:

Tonight Is a Really Big Moment for the Repeal-and-Replace Effort

Brace yourselves… the Not-The-State-of-the-Union-Address is tonight! (The first address of a new president is not considered a “State of the Union Address” but merely a “Joint Address to Congress.”) What’s the over/under on the number of times some Congressional Democrat emulates Joe Wilson and yells out during Trump’s speech? Does that lawmaker send out his first fundraising e-mail before the speech ends?

It is not reassuring to hear President Trump declare, “Nobody knew health care could be so complicated.” Er, yes, Mr. President, just about anyone who spent more than ten minutes looking at the issues involved could see that coming.

You need enough young people to purchase health insurance that they’re not likely to need and effectively overpay in order to cover the costs of the elderly and sick who will underpay. You need competition in plans in order to reduce prices, except most people find too many choices confusing and aren’t great at predicting what kind of health care costs they’ll have in the future. You want to ensure no one is rejected from insurance for preexisting conditions and can afford their premiums, copays and deductibles, but health insurance companies will tell you there’s simply no way for them to make money on a customer like that.

You have a customer base that wants their insurance plans to cover all of the costs of birth control, neonatal care, breast pumps, trips to the emergency room, prescription drugs, pediatric services, lab tests, mental health care and therapy… and they want low premiums.

Ideally, you would enact some kind of tort reform, to make it harder for ambulance-chasing lawyers to sue doctors; this would reduce doctors’ expenses on malpractice insurance… but you don’t want to make it too hard to win damages in cases of genuine malpractice.

The House Freedom Caucus wants to get rid of all of the taxes enacted in Obamacare: the medical device tax, reduced deductions for generous “Cadillac” health insurance plans, a ten percent tax on tanning salon customers. Of course, without those, you have less money coming in to pay for everything the bill includes.

As noted in last week’s interview with Scott Walker, one option is to take away the subsidy under Obamacare but replace it with a tax credit, ranging from $2,000 to $4,000. If that sounds like swapping out one form of government assistance for another to you, a couple of North Carolina Republican members of Congress agree with you.

After examining a draft proposal that included that option, Rep. Mark Walker declared,  “the bill contains what increasingly appears to be a new health insurance entitlement with a Republican stamp on it.” Rep. Mark Meadows said Monday, “I’m opposed to refundable tax credits in the way the current draft, as I understand it, lays it out because it actually increases – provides for a new entitlement program.”

If President Trump comes down heavily on one side or the other of this issue, it would probably persuade a portion of Congressional Republicans. Trump could say, “look, the people who elected me are angry because they feel like they can’t afford anything anymore, including their health insurance. I’m not going to make my first major act as president to yank away the financial assistance they’ve got.”

Or he could say, “a major reason health insurance is such a mess is the endless perception that somebody else will pay for most of the costs.  Everybody’s got to take responsibility for paying for their own health care. If we get enough competition among insurance providers, costs will go down.”

Or he could just say, “it’s gonna be terrific, you just wait and see,” and not provide any details on these issues.

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