The number of uninsured Americans is rising. Last year, 27.4 million Americans went without health insurance, an increase of 700,000 from 2016, according to a just-published analysis from the Kaiser Family Foundation. Government mandates deserve much of the blame. Regulations and red tape have driven premiums through the roof, pricing many Americans out of the insurance market. Nearly half of uninsured people cite high premiums and prohibitive deductibles as the reasons they aren’t covered. Free-market reforms would enable millions more people to afford insurance that fits their needs and those of their family.
What will Nancy Pelosi do now once she is back in the Speaker’s chair? In light of Judge Reed O’Connor’s recent ruling that Obamacare is unconstitutional and that the entire law must be scrapped, there is likely to be strong pressure to pass some sort of legislation to improve protections for people with pre-existing conditions. Of course, Rep. Pelosi also will face pressure from those who want to resurrect the idea of a public option—an idea she supported during the fierce debates of 2009-2010, but which foundered for lack of votes in the race to the finish line. And with various progressives jockeying for position in the 2020 race, there likewise will be a vocal minority urging a push for Medicare for All. To her credit, Rep. Pelosi has wisely desisted from endorsing that singularly bad idea. But it would be a shame if Nancy Pelosi squandered this opportunity by merely re-arranging deck chairs on the Titanic. By now it is manifestly clear that Obamacare—like so many ambitious government programs before it–has massively overpromised and underdelivered.
Most of the real action on health reform is likely to happen in the regulatory space over the next two years, and the Trump administration can build on the opportunities it already has created with a regulatory fix that would increase access to health insurance for working families.
We submitted a comment letter on Friday recommending a change to the administration’s proposed rule that adds flexibility to Health Reimbursement Arrangements. We recommend the administration also allow funds from one spouse to be used to buy into group health coverage offered by the employer of the other working spouse.
About one-fourth of employees offered health insurance at work do not participate, generally because of cost. This change would increase uptake by allowing spouses to use funds deposited into an HRA account by one employer to obtain a family insurance policy offered by the other spouse’s employer.
When a federal judge recently ruled that the Affordable Care Act is unconstitutional, many in the media were caught off guard. Little attention had been paid to the case, which was brought by the attorneys general of 20 states and by the Texas Public Policy Foundation (representing individual clients who have been harmed by Obamacare).
But when U.S. District Judge Reed O’Connor handed down his ruling, he suddenly had everyone’s attention. What has followed has been an exercise in opinion-forming and prediction-making—based on too little information and even less understanding of how we got here.
After a federal judge in Texas declared Obamacare unconstitutional on what I saw as shaky legal grounds, I declared the decision an ” assault on the rule of law.” On Wednesday, I met with Rob Henneke, a lawyer for individual plaintiffs in the suit, who said that myself and other critics “missed the mark” in our analysis, and he explained why. Henneke, general counsel at the Texas Public Policy Foundation, who has been serving as attorney for the individual plaintiffs, has advanced an alternative theory that sees the requirement to purchase insurance (the mandate) as separate from the tax on going uninsured. All major differences flow from the way one views that distinction.
The new Democratic majority in the House will hold the first hearings on Medicare-for-All legislation, a longtime goal of the party’s left, after Speaker Nancy Pelosi lent her support for the process.
“It’s a huge step forward to have the speaker’s support,” said Rep. Pramila Jayapal (D-WA), who will be the House sponsor of the legislation, usually denoted as HR 676. “We have to push on the inside while continuing to build support for this on the outside.”