Not letting the Obamacare crisis go to waste

The program dies quickly without insurance company subsidies

- Tuesday, April 25, 2017

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Republicans should take a lesson from Democrats. During President Obama’s battle to enact Obamacare, his chief of staff, Rahm Emanuel, famously said, “You never want a serious crisis to go to waste. What I mean by that is an opportunity to do things you could not do before.”

I agree. Eight years later, Americans are in a serious crisis because of Obamacare. And now there’s a huge opportunity to deep-six the law. Republicans should not let it go to waste.

It’s time to pivot. The GOP leadership’s American Health Care Act (AHCA) failed. The Obamacare replacement bill was opposed by conservatives and moderates alike. Rep. Justin Amash, Michigan Republican, called the bill “Obamacare 2.0.” The Republican House Freedom Caucus refused to support it. And the longer moderate Republicans looked at its details, the less they liked it. After attempting to pass AHCA on Obamacare’s seventh anniversary, the bill died.

So, why waste time trying to resurrect AHCA or pass another Obamacare replacement bill? Americans want Obamacare repealed.

Republicans should begin by following through with President Trump’s threat. End the unauthorized Obamacare cost-sharing reduction (CSR) subsidy payments, estimated to be $7 billion in 2016. This one action could sink much of Obamacare. Mr. Trump recently told The Wall Street Journal that “Obamacare is dead next month if it doesn’t get that money.”

Congress should make it so.

Cost-sharing reduction subsidies were authorized by the Affordable Care Act (ACA) to reduce the cost of deductibles and copayments for lower-income Americans, but the Democrat-led Congress never appropriated funding for payments. The Obama administration ignored this inconvenient fact and gave billions of dollars to health insurers in CSR payments. This allowed millions of Americans to sign up for Obamacare coverage they could only afford because the government subsidized their premiums through taxpayer-funded Advance Premium Tax Credits, as well as their deductibles and copayments through taxpayer-funded CSR payments.

In 2014, the Republican-led Congress sued to block the Obamacare administration from making these unauthorized payments. U.S. District Judge Rosemary Collyer ruled in favor of Congress, but let the payments continue, pending the outcome of an appeal by the administration. The 2016 presidential election changed everything. President Trump now has the power to simply drop the administration’s appeal and stop the payments.

Without payments, the game is up. The subsidy-ridden veil surrounding the true cost of Obamacare will be ripped to shreds. And health plan premiums, loaded with ACA mandates and regulatory requirements, will skyrocket to their actual cost.

The fallout will be immediate. Americans who could never afford Obamacare-priced premiums will refuse to buy coverage. Enrollment will plummet. The healthy will forgo coverage. The sick will pay whatever it takes to keep coverage. Health plans will lose their taxpayer-funded financial cushion and exit the Obamacare exchanges in droves. And the exchange, funded by a surcharge on monthly premiums, will implode.

This is where crisis and opportunity come together.

The Affordable Care Act dismantled the insurance markets that existed in 50 states and replaced them with one “federal marketplace” ( and a few interconnected state exchanges. The ACA also favored, and thus empowered, large managed care corporations. Section 1302(e) of the law prohibits the sale of catastrophic coverage — major medical indemnity insurance policies — to anyone over the age of 29. As a result, millions lost these affordable policies and were forced to buy limited options of unaffordable coverage offered through the Obamacare exchanges.

It’s time to right the Obamacare wrong. The real marketplace exists outside of government-controlled exchanges. Affordable insurance exists outside of managed care corporations. True insurance exists outside of Obamacare coverage.

Mr. Trump should drop the administration’s appeal against the Republican lawsuit and stop CSR payments. Republicans in Congress should refuse to fund CSR subsidies. The pending Continuing Resolution, which appropriates money to keep the federal government funded, should not include subsidies. And Republicans in every statehouse around America should reassert their right to direct health care within their borders and enact laws to make it so.

The time, and opportunity, to end Obamacare is now.

• Twila Brase, a registered nurse, is president and co-founder of Citizens’ Council for Health Freedom.

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