What Will Replace Obamacare?

Obamacare is dead.  Long live ... what?  That is unclear.  "Vice President-elect Mike Pence said Tuesday that repealing and replacing ObamaCare would be the first item on President-elect Donald Trump's agenda," according to Fox News.  Its successor will emerge from a series of discussions soon to take place.  "It’ll be the first thing out of the gate. ... He wants the Congress when they convene in early January to take up the task of repealing and replacing ObamaCare first."

One of the possible replacements could be the Health Care Compact if only because the list of those who supported H.J.Res.50 reads like a Who's Who in the incoming administration.

  • Indiana (home to VP-elect Pence)
  • Alabama (AG-nominee Sessions)
  • Georgia (HHS nominee Price)
  • Texas (endorsed by Sen. John Cornyn)
  • Kansas (proposed and endorsed by Rep. Pompeo and Sec. of State Kris Kobach)
  • Oklahoma (endorsed by Sen. James Lankford)

The program that Mother Jones once derided as "a longshot" and pipe-dream of a delusional Tea Party has now come within measurable distance of becoming a serious contender to replace Obamacare.

According to the Congressional record the HCC  would give "primary responsibility for regulation of health care to the state. Federal and state laws remain in effect in a member state until suspended by the state.  A member state is responsible for federal funding obligations that remain in effect in the state. Each year, a member state is entitled to federal funds equal to the total federal spending on health care in the state during FY2010, adjusted for inflation and population."  It turns federal funds into what amounts to a block grant, leaving states free to create, cooperate and compete.

The HCC specifically does not affect the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration. "The compact establishes the Interstate Advisory Health Care Commission to collect information and data to assist member states in their regulation of health care. The commission may make non-binding recommendations to the member states."

That would ironically make it an ideal vehicle for states like Vermont or California whose voters are largely opposed to the Trump administration to roll their own health care and effort in which other like-minded liberal states can join them.  HHS nominee Tom Price's rhetoric suggests he would have no objections in principle to  taking Washington out of the picture. In a quote cited by the Wall Street Journal Price said:  “We think it’s important that Washington not be in charge of health care,” the six-term congressman said in an interview this summer. “The problem that I have with Obamacare is that its premise is that Washington knows best.”

The general tenor of an Obamacare replacement plans emphasize giving consumers money to pick and choose policies instead of forcing them to consume Federally prescribed products. Typical is this proposal by Michael Cannon of Cato in the New York Times.

How can Congress make health care better, more affordable, and more secure for Medicare enrollees and everyone else? Instead of mismanaging a $600 billion health-insurance scheme for 60 million elderly and disabled Americans, or giving seniors vouchers to choose from among different versions of a government-designed health plan, Congress should simply distribute Medicare’s budget to enrollees as cash. Just like Social Security.

Turning Medicare into a cash-transfer program would eliminate nearly every Medicare rule put in place by special interests to preserve their outdated business models and stifle innovation. It would spark an innovation revolution in health insurance and health care delivery.

Ideally it would be an ideal vehicle for liberals with an unshakable antipathy to the Trump administration the HCC to do healthcare themselves, an option clearly preferable to accepting the imposition of any centrally prescribed Obamacare replacement now that the presidency is not in their control.  Still they may oppose it simply because it was "not invented here".

The HCC like so many other dark horses in this year of unexpected upsets is now a real player.  Too many impossible things have taken place for anyone to easily dismiss anything out of hand now.  The next few weeks will give a clearer indication of where health care policy is trending.  But one thing is for sure.  The long shot's not such a long shot any more.

Follow Wretchard on Twitter


Support the Belmont Club by purchasing from Amazon through the links below.

Books:

A Spontaneous Order: The Capitalist Case For A Stateless Society, by Christopher Chase Rachels. A presentation of anarcho-capitalist ideals described by critics/readers as concise, rigorous and accessible.

True Believer: Stalin's Last American Spy, by Katie Marton. The story of Noel Field, an Ivy League-educated, US State Department employee who spied for Stalin in the 1930s and '40ss, based on Field family correspondence, Soviet Secret Police records, and reporting on key players from Alger Hiss, CIA Director Allen Dulles, World War II spymaster “Wild Bill” Donovan to Josef Stalin.

The Short Drop, Bestselling first novel in the Gibson Vaughn series by Matthew Fitzsimmons. A political thriller.

Empires of the Sand: The Struggle for Mastery in the Middle East, 1789-1923, by Efraim Karsh and Inari Karsh. This book rejects the view of modern Middle Eastern history as an offshoot of global power politics. It argues, backed by a wealth of archival material, that the main impetus for the developments during this period came from the Hashemites and other local actors, an interpretation that affords daringly new ways of viewing the region's past as well as its volatile present.


Did you know that you can purchase some of these books and pamphlets by Richard Fernandez and share them with your friends? They will receive a link in their email and it will automatically give them access to a Kindle reader on their smartphone, computer or even as a web-readable document.

The War of the Words, Understanding the crisis of the early 21st century in terms of information corruption in the financial, security and political spheres

Rebranding Christianity, or why the truth shall make you free

The Three Conjectures, reflections on terrorism and the nuclear age

Storming the Castle, why government should get small

No Way In at Amazon Kindle. Fiction. A flight into peril, flashbacks to underground action.

Storm Over the South China Sea, how China is restarting history in the Pacific

Tip Jar or Subscribe or Unsubscribe to the Belmont Club