Does the Freedom Caucus Have a Plan?

April 5, 2017

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The House Freedom Caucus (HFC) has pushed for full repeal of Obamacare…until now. These Republicans want the Affordable Care Act (ACA) fully repealed. They opposed Speaker Paul Ryan’s American Health Care Act (AHCA) and stopped two floor votes on AHCA (ah-ka). But recently, Congressman Mark Meadows, told the Washington Examiner:
 
The Freedom Caucus has asked for two [mandates] to be included in the repeal, which would bring us to a total of four of the 12 Obamacare mandates. That’s our ask. These two Obamacare mandates repealed in exchange for yes votes…We’re talking about asking for a little over 15 percent of the Obamacare mandates to be repealed and we can’t get a yes from that?…The request is pretty simple: 2 of 12 Obamacare mandates when we campaigned on the fact that we were going to repeal all 12.
 
Surprisingly, the HFC wants only two things: repeal of “essential health benefits” (EHB) -- a set of 10 broad government–mandated services -- and repeal of “community rating” (CR), which charges everyone similar rates regardless of health status. Does Meadows have a plan to work this limited demand into a full repeal of all 2,700 pages?
 
Former GOP research analyst Chris Jacobs says unless the law’s costly “guaranteed issue” (GI) mandate for people with pre-existing conditions and its “actuarial value” (AV) mandate on insurers are also repealed, it won’t work. He suggests repeal of all four insurance mandates (EHB, CR, GI, AV) or a full repeal of the law -- with state high-risk pools (HRP) for people with pre-existing conditions.
 
But just two days ago, Vice President Pence floated the idea of giving HHS Secretary Tom Price, M.D. the authority to grant waivers to let states roll back just the EHB and CR requirements. But these requirements would stay in law for a liberal administration to resurrect.
 
If only EHB and CR are repealed, the following politically-difficult results are likely:
 
·      HIGH COSTS: With GI still in place and CR repealed, expect MUCH higher premiums for people with pre-existing conditions.
 
·      REDUCED ACCESS? With GI still in place and EHB repealed, insurers could eliminate access to some costly treatments and medications to discourage enrollment of costly patients. However, they’d still have to comply with state law on mandated benefits.
 
·      INSURER BAILOUT: To reduce premiums, states could use the $115 billion federal AHCA “stability fund” to establish state “reinsurance” programs, like Minnesota just did in anticipation of AHCA, that protect insurers by forcing state and federal taxpayers to cover major expenses of ALL people who buy their own health insurance.
 
Even if all four mandates are repealed, ACHA+HFC doesn’t come close to repealing the 2,700-page law and its 40,000 pages of regulatory documents. For example, ACA exchanges, government surveillance systems, and federal controls over the practice of medicine would remain. These include bureaucracies like CCIIO, PCORI, CMMI, IPAB and their prescriptive pilot projects. That said, with the repeal of Obamacare taxes, it’s possible these federal agencies and grant programs would run out of cash.
 
Congressman Mo Brooks (R-AL) has a two-page bill to fully repeal the Affordable Care Act. He wants Congress to bring H.R. 1718 up for a vote and see who actually votes for full repeal. Great idea. Very bold and very clarifying. Congress should try a real repeal.
 
Until they try, how do they know what is or is not possible?
 
They’re done talking for now it appears, but when they return from break, a full repeal should be considered. One of the things full repeal will do is eliminate the ACA’s prohibition on catastrophic coverage (§1302(e)). This repeal is essential for restoring affordable premiums, market competition, and pocketbook prices for routine and minor care. The repeal of this prohibition would lead to true insurance that does not interfere in medical decisions.
 
Freedom is our goal. Patients and doctors should operate in direct-payment relationships, not costly, restrictive third-party payment systems. That’s the future of health freedom, as exemplified by our initiative, The Wedge of Health Freedom. Congress should focus on real freedom with a full repeal.
 
Focused on freedom,
 
Twila Brase, RN, PHN
President and Co-founder