Justin Amash

Amash: “AHCA repeals fewer than 10 percent of the provisions in the Affordable Care Act”

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Amash: "AHCA repeals fewer than 10 percent of the provisions in the Affordable Care Act"

The fist bumps com­ing from the GOP after pass­ing the Amer­i­can Health Care Act in the House were plen­ti­ful. Repub­li­cans around the coun­try were giv­ing each other high-​fives for hav­ing finally made the first real steps towards repeal­ing Oba­macare. Here’s the prob­lem. We haven’t seen the begin­ning of the repeal of Oba­macare. We’ve seen the seeds of Trump­care being planted. Per­haps the bet­ter name for it would be “Obamacarelite.”

This a repeal in name only. Con­gress­man Justin Amash revealed the truth about the AHCA in a Face­book post yes­ter­day (emphases are mine):

This is not the bill we promised the Amer­i­can peo­ple. For the past seven years, Repub­li­cans have run for Con­gress on a com­mit­ment to repeal Oba­macare. But it is increas­ingly clear that a bill to repeal Oba­macare will not come to the floor in this Con­gress or in the fore­see­able future.

When Repub­li­can lead­ers first unveiled the Amer­i­can Health Care Act, a Demo­c­ra­tic friend and col­league joked to me that the bill wasn’t a new health care pro­posal; it was pla­gia­rism. He was right.

The AHCA repeals fewer than 10 per­cent of the pro­vi­sions in the Afford­able Care Act. It is an amend­ment to the ACA that delib­er­ately main­tains Obamacare’s frame­work. It refor­mu­lates but keeps tax cred­its to sub­si­dize pre­mi­ums. Instead of an indi­vid­ual man­date to pur­chase insur­ance, it man­dates a pre­mium sur­charge of 30 per­cent for one year fol­low­ing a lapse of cov­er­age. And the bill con­tin­ues to pre­serve cov­er­age for depen­dents up to age 26 and peo­ple with pre-​existing conditions.

I want to empha­size that last point. The bill does not change the ACA’s fed­eral require­ments on guar­an­teed issue (pro­hi­bi­tion on pol­icy denial), essen­tial health ben­e­fits (min­i­mum cov­er­age), or com­mu­nity rat­ing (pro­hi­bi­tion on pric­ing based on health sta­tus). In short, Obamacare’s pre-​existing con­di­tions pro­vi­sions are retained.

The lat­est ver­sion of the AHCA does allow any state to seek a waiver from cer­tain insur­ance man­dates, but such waivers are lim­ited in scope. Guar­an­teed issue can­not be waived. Nobody can be treated dif­fer­ently based on gen­der. And any per­son who has con­tin­u­ous cov­er­age — no lapse for more than 62 days — can­not be charged more regard­less of health status.

Con­sider what this means: Even in a state that waives as much as pos­si­ble, a per­son with a pre-​existing con­di­tion can­not be pre­vented from pur­chas­ing insur­ance at the same rate as a healthy per­son. The only require­ment is that the per­son with the pre-​existing con­di­tion get cov­er­age — any insurer, any plan — within 62 days of los­ing any prior coverage.

If a per­son chooses not to get cov­er­age within 62 days, then that per­son can be charged more (or less) based on health sta­tus for up to one year, but only (1) in lieu of the 30 per­cent penalty (see above), (2) if the per­son lives in a state that has estab­lished a pro­gram to assist indi­vid­u­als with pre-​existing con­di­tions, and (3) if that state has sought and obtained the rel­e­vant waiver. Here in Michi­gan, our Repub­li­can gov­er­nor has already stated he won’t seek such a waiver, accord­ing to reports.

So why are both par­ties exag­ger­at­ing the effects of this bill? For Pres­i­dent Trump and con­gres­sional Repub­li­cans, the rea­son is obvi­ous: They have long vowed to repeal (and replace) Oba­macare, and their base expects them to get it done. For con­gres­sional Democ­rats, it’s an oppor­tu­nity to scare and ener­gize their base in antic­i­pa­tion of 2018. Nei­ther side wants to present the AHCA for what it is — a more lim­ited pro­posal to rework and reframe parts of the ACA, for bet­ter or for worse.

In March, when this bill was orig­i­nally sched­uled to come to the floor, it was cer­tainly “for worse.” The pre­vi­ous ver­sion pro­vided few clear advan­tages over the ACA, yet it hap­haz­ardly added pro­vi­sions to mod­ify essen­tial health ben­e­fits with­out mod­i­fy­ing com­mu­nity rat­ing — plac­ing the sick­est and most vul­ner­a­ble at greater risk.

Over the last month, sev­eral small but impor­tant changes were made to the bill. The cur­rent ver­sion aban­dons that fatally flawed approach to essen­tial health ben­e­fits (though the new approach includes new flaws), incor­po­rates an invis­i­ble risk shar­ing pro­gram, and per­mits lim­ited state waivers. These changes may slightly bring down (or at least slow down the increase in) pre­mi­ums for peo­ple who have seen rates go up. Even so, the AHCA becomes only mar­gin­ally bet­ter than the ACA.

Many have ques­tioned the process that led up to the vote on May 4. I have pub­licly expressed my dis­gust with it. The House again oper­ated in top-​down fash­ion rather than as a delib­er­a­tive body that respects the diver­sity of its mem­ber­ship. But it’s impor­tant to acknowl­edge that the bulk of this bill (123 pages) was released on March 6. Only about 15 pages were added after late March. Mem­bers of Con­gress were given suf­fi­cient time to read and under­stand the entire bill.

While an ear­lier ver­sion of the AHCA included a CBO score, the types of changes made to the AHCA in more recent stages ren­der an updated score highly spec­u­la­tive and prac­ti­cally mean­ing­less. For that score to be use­ful, the Con­gres­sional Bud­get Office would have to effec­tively pre­dict which states will seek waivers, which waivers they will seek, and when they will seek them. This com­plex analy­sis of the polit­i­cal processes and choices of every state is beyond anyone’s capa­bil­ity. I weighed the lack of an updated score accordingly.

When decid­ing whether to sup­port a bill, I ask myself whether the bill improves upon exist­ing law, not whether I would advo­cate for the pol­icy or pro­gram if I were start­ing with a blank slate. In other words, the proper analy­sis is not whether it makes the law good but rather whether it makes the law bet­ter. In this case, I felt com­fort­able advanc­ing the bill to the Sen­ate as a mar­ginal improve­ment to the ACA. The House has voted more than 30 times to amend (not just repeal) Oba­macare since I’ve been in Con­gress, and I have sup­ported much of that leg­is­la­tion, too, on the prin­ci­ple of incre­men­tal­ism. If it advances lib­erty even a lit­tle (on net), then I’m a yes.

Nonethe­less, the ACA will con­tinue to drive up the cost of health insur­ance — while bol­ster­ing the largest insur­ance com­pa­nies — and the mod­i­fi­ca­tions con­tained in the AHCA can­not save it. Many of the AHCA’s pro­vi­sions are poorly con­ceived or improp­erly imple­mented. At best, it will make Oba­macare less bad.

The Framers of the Con­sti­tu­tion under­stood that fed­er­al­ism — the divi­sion of pow­ers between the national and state gov­ern­ments — would max­i­mize the hap­pi­ness of Amer­i­cans. As long as Wash­ing­ton dic­tates health insur­ance pol­icy to the entire coun­try, there will be mas­sive ten­sion and dis­plea­sure with the sys­tem. I’ve always said, and I will con­tinue to say, we need to start over: Fully repeal Oba­macare, let the peo­ple of each state choose their own approach, and work together in a non­par­ti­san manner.

The Con­gress­man is cor­rect when he says that it’s his duty to decide whether or not a bill is an improve­ment on exist­ing law. How­ever, one should also con­sider whether it’s pos­si­ble for the law to be dra­mat­i­cally improved with more effort put towards big­ger or smaller changes. In this case, I believe Amash would have voted against the bill if he believed there was a full repeal pos­si­ble. He and the Free­dom Cau­cus weighed the pos­si­bil­i­ties and decided that this was the best they were going to get. It was right move from a leg­isla­tive per­spec­tive, but it also rein­vig­o­rates the neces­sity for the Fed­er­al­ist Party to rise.

It’s a shame that small-​government-​minded rep­re­sen­ta­tives are forced to pick between the lesser of two evils. Mil­lions of vot­ers can relate to this cir­cum­stance as we’re often faced with pick­ing between Mr. Big Gov or his oppo­nent, Mrs. Big­ger Gov. As long as the two-​party sys­tem holds pri­macy over all poten­tial chal­lengers, we will always be faced with this obtuse binary choice. The time for change is now.

The fist bumps coming from the GOP after passing the American Health Care Act in the House were plentiful. Republicans around the country were giving each other high-fives for having finally made the first real steps towards repealing Obamacare. Here’s the problem. We haven’t seen the beginning of the repeal of Obamacare. We’ve seen the seeds of Trumpcare being planted. Perhaps the better name for it would be “Obamacarelite.”

This a repeal in name only. Congressman Justin Amash revealed the truth about the AHCA in a Facebook post yesterday (emphases are mine):

This is not the bill we promised the American people. For the past seven years, Republicans have run for Congress on a commitment to repeal Obamacare. But it is increasingly clear that a bill to repeal Obamacare will not come to the floor in this Congress or in the foreseeable future.

When Republican leaders first unveiled the American Health Care Act, a Democratic friend and colleague joked to me that the bill wasn’t a new health care proposal; it was plagiarism. He was right.

The AHCA repeals fewer than 10 percent of the provisions in the Affordable Care Act. It is an amendment to the ACA that deliberately maintains Obamacare’s framework. It reformulates but keeps tax credits to subsidize premiums. Instead of an individual mandate to purchase insurance, it mandates a premium surcharge of 30 percent for one year following a lapse of coverage. And the bill continues to preserve coverage for dependents up to age 26 and people with pre-existing conditions.

I want to emphasize that last point. The bill does not change the ACA’s federal requirements on guaranteed issue (prohibition on policy denial), essential health benefits (minimum coverage), or community rating (prohibition on pricing based on health status). In short, Obamacare’s pre-existing conditions provisions are retained.

The latest version of the AHCA does allow any state to seek a waiver from certain insurance mandates, but such waivers are limited in scope. Guaranteed issue cannot be waived. Nobody can be treated differently based on gender. And any person who has continuous coverage—no lapse for more than 62 days—cannot be charged more regardless of health status.

Consider what this means: Even in a state that waives as much as possible, a person with a pre-existing condition cannot be prevented from purchasing insurance at the same rate as a healthy person. The only requirement is that the person with the pre-existing condition get coverage—any insurer, any plan—within 62 days of losing any prior coverage.

If a person chooses not to get coverage within 62 days, then that person can be charged more (or less) based on health status for up to one year, but only (1) in lieu of the 30 percent penalty (see above), (2) if the person lives in a state that has established a program to assist individuals with pre-existing conditions, and (3) if that state has sought and obtained the relevant waiver. Here in Michigan, our Republican governor has already stated he won’t seek such a waiver, according to reports.

So why are both parties exaggerating the effects of this bill? For President Trump and congressional Republicans, the reason is obvious: They have long vowed to repeal (and replace) Obamacare, and their base expects them to get it done. For congressional Democrats, it’s an opportunity to scare and energize their base in anticipation of 2018. Neither side wants to present the AHCA for what it is—a more limited proposal to rework and reframe parts of the ACA, for better or for worse.

In March, when this bill was originally scheduled to come to the floor, it was certainly “for worse.” The previous version provided few clear advantages over the ACA, yet it haphazardly added provisions to modify essential health benefits without modifying community rating—placing the sickest and most vulnerable at greater risk.

Over the last month, several small but important changes were made to the bill. The current version abandons that fatally flawed approach to essential health benefits (though the new approach includes new flaws), incorporates an invisible risk sharing program, and permits limited state waivers. These changes may slightly bring down (or at least slow down the increase in) premiums for people who have seen rates go up. Even so, the AHCA becomes only marginally better than the ACA.

Many have questioned the process that led up to the vote on May 4. I have publicly expressed my disgust with it. The House again operated in top-down fashion rather than as a deliberative body that respects the diversity of its membership. But it’s important to acknowledge that the bulk of this bill (123 pages) was released on March 6. Only about 15 pages were added after late March. Members of Congress were given sufficient time to read and understand the entire bill.

While an earlier version of the AHCA included a CBO score, the types of changes made to the AHCA in more recent stages render an updated score highly speculative and practically meaningless. For that score to be useful, the Congressional Budget Office would have to effectively predict which states will seek waivers, which waivers they will seek, and when they will seek them. This complex analysis of the political processes and choices of every state is beyond anyone’s capability. I weighed the lack of an updated score accordingly.

When deciding whether to support a bill, I ask myself whether the bill improves upon existing law, not whether I would advocate for the policy or program if I were starting with a blank slate. In other words, the proper analysis is not whether it makes the law good but rather whether it makes the law better. In this case, I felt comfortable advancing the bill to the Senate as a marginal improvement to the ACA. The House has voted more than 30 times to amend (not just repeal) Obamacare since I’ve been in Congress, and I have supported much of that legislation, too, on the principle of incrementalism. If it advances liberty even a little (on net), then I’m a yes.

Nonetheless, the ACA will continue to drive up the cost of health insurance—while bolstering the largest insurance companies—and the modifications contained in the AHCA cannot save it. Many of the AHCA’s provisions are poorly conceived or improperly implemented. At best, it will make Obamacare less bad.

The Framers of the Constitution understood that federalism—the division of powers between the national and state governments—would maximize the happiness of Americans. As long as Washington dictates health insurance policy to the entire country, there will be massive tension and displeasure with the system. I’ve always said, and I will continue to say, we need to start over: Fully repeal Obamacare, let the people of each state choose their own approach, and work together in a nonpartisan manner.

The Congressman is correct when he says that it’s his duty to decide whether or not a bill is an improvement on existing law. However, one should also consider whether it’s possible for the law to be dramatically improved with more effort put towards bigger or smaller changes. In this case, I believe Amash would have voted against the bill if he believed there was a full repeal possible. He and the Freedom Caucus weighed the possibilities and decided that this was the best they were going to get. It was right move from a legislative perspective, but it also reinvigorates the necessity for the Federalist Party to rise.

It’s a shame that small-government-minded representatives are forced to pick between the lesser of two evils. Millions of voters can relate to this circumstance as we’re often faced with picking between Mr. Big Gov or his opponent, Mrs. Bigger Gov. As long as the two-party system holds primacy over all potential challengers, we will always be faced with this obtuse binary choice. The time for change is now.