There’s “a time to break down,” the Bible teaches, “and a time to build up.” This is the moment for both, and the moment is called “repeal and replace.” The end of Obamacare and the birth of the American Health Care Act are upon us this week, now that crucial parts of the proposed replacement law have been revealed. Securing a better health care system was the promise to the American people that put Donald Trump in the White House. Enacting a viable alternative won’t guarantee Mr. Trump a happy presidency, but failure to do it would guarantee a miserable presidency.
The new Republican plan revealed Monday would use tax credits to offset the cost of health insurance — scrapping the Obamacare subsidies for lower-income Americans, the expansion of coverage through Medicaid, and the mandates and taxes that have encouraged public disdain for big government. The plan would preserve popular elements of Obamacare that enable children to remain on their parents’ plan until age 26 and prohibit insurers from penalizing those with existing medical ailments.
The plan would make Planned Parenthood ineligible for reimbursement from federal funds. “We’ve been listening very carefully to our Republican members for months now to make sure we get it right,” says Rep. Kevin Brady of Texas, chairman of the House Ways and Means Committee. “I am confident we are going to pass this.”
But passage will require threading a needle between conservatives who fear that tax credits, ranging from $2,000 to $4,000, depending on income and age, could vastly increase costs. Democrats threaten to fight the plan if it costs some Americans their health-care coverage. With a 19-seat House majority and a two-seat advantage in the Senate, Republicans don’t have much margin for error.
Some among the majority have chafed at having little opportunity to contribute to the process. Sen. Rand Paul of Kentucky, who calls the replacement plan “Obamacare Lite,” led reporters through the corridors of the U.S. Capitol last week searching for the draft bill, tweeting: “What is the House leadership trying to hide?” Democrats joined the procession, delighted to help a Republican harass his own.
House Speaker Paul Ryan called Mr. Paul’s antics “a publicity stunt” and disputed Sen. Paul’s assertion that the health-care replacement is only slightly less dysfunctional than the Obamacare. “The things he described are not accurate,” Mr. Ryan says. He says enacting the new law will proceed using “regular order,” with opportunities for debate and amendments. There won’t be a repeat of Nancy Pelosi’s explanation of Obamacare that “we have to pass the bill so that you can find out what is in it.”
The Republicans’ health care replacement is modeled on the plan presented by Rep. Tom Price of Georgia, a physician and the new secretary of Health and Human Services. It removes the individual mandate that forces Americans to purchase health care under penalty of law, and returns the freedom of insurance companies to offer a wide selection of insurance options, unencumbered by suspect extras that run up the price. The inclusion of health savings accounts would give consumers the incentive to budget their medical dollars wisely.
Rather than allow the perfect to become the enemy of the good, Republicans must return the nation’s health care to the hands of patients and their doctors. Congressional credibility has an expiration date, and there’s no time to lose to redeem the Republican pledge to relieve Americans from the burden of a failed socialist-style experiment in health care.
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