GOP's 'centrist' concerns about ObamaCare are not based in reality
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A growing divide among congressional Republicans has given proponents of the Affordable Care Act a glimmer of hope after three months in which the demise of the ACA seemed all but inevitable. The debate emerged after some so-called “centrist” Republicans announced they oppose conservatives’ plan to eliminate Medicaid expansion and after other Republicans announced they would likely not support repealing ACA without a replacement plan firmly in place.

As reported by The Hill on Tuesday, the infighting has led a number of Democrats to speculate ACA might be safer than many have thought since the November elections ended with Republicans firmly in control of the White House, House of Representatives, and Senate. “This is very big,” former Obama aide Jon Favreau said on Twitter. “GOP doesn’t have enough votes in the Senate to end Medicaid expansion, which means they wouldn’t be able to pass anything.”


Centrist Republicans’ concerns over Medicaid expansion and having a replacement plan accompany a repeal of the ACA are not surprising, but they are completely devoid of reality. Medicaid expansion has been an unmitigated disaster. By promising to indefinitely fund the vast majority of costs associated with expanding the Medicaid population, states have had absolutely no incentive to create policies that would help people move away from dependence on government and toward self-sufficiency, and many individuals, including countless young people, have been incentivized to avoid pursuing higher-paying jobs (or work at all) to ensure they have continuous access to nearly free health insurance.


These are some of the primary reasons Medicaid expansion has cost significantly more than the Obama administration and congressional Democrats projected it would. In November, The Foundation for Government Accountability issued a report analyzing data from 24 of the 29 states that have expanded Medicaid. FGA found more than 11 million able-bodied adults have enrolled in Medicaid since expansion was first implemented, “exceeding projections … by an average of 110 percent,” according to Fox News’ analysis of the FGA report.

Not only have Medicaid rolls skyrocketed higher than any of the proponents of the ACA predicted, it’s also costing much more to cover individuals than originally thought. In the Centers for Medicare and Medicaid Services’ 2015 Actuarial Report on Medicaid, it found the estimated per-enrollee cost for Medicaid in 2015 was 49 percent higher than the initial estimates.

These issues are vital, because states must begin covering the cost of Medicaid expansion enrollees (5 percent of total costs this year), eventually being required to pay for 10 percent of the total costs by 2020, a share many states now believe they won’t be able to afford.

Congressional Republicans worried about what might happen should Medicaid expansion be repealed should instead fear the consequences of keeping Medicaid expansion in place. Not only is the program unsustainable in the long term, it may actually be hurting those Americans who are most disadvantaged. As reported by Ellen Weaver, CEO of the Palmetto Promise Institute, and Caleb Crosby, president and CEO of the Alabama Policy Institute, in an article in National Review, “Because ObamaCare provides a 90–100 percent federal match to states covering the able-bodied, but only a 50–75 percent match to those covering individuals with disabilities, many states have chosen to prioritize coverage of the able-bodied. In some cases, they have gone so far as to cut coverage for the most vulnerable even while expanding it elsewhere. There are nearly 600,000 individuals with disabilities stuck — and in some cases, dying — on waiting lists, unable to access the care they need through Medicaid.”

Even more foolish is the argument centrist Republicans are making about the necessity of having a full replacement plan in place before the ACA is repealed. They argue it would be unwise to repeal ACA without a replacement in place because it could create further instability in the market, even if legislation grants as many as two years for legislators to put a new plan in place, as the current repeal proposal does.

The alleged instability so many in Congress fear creating could just as easily be used as a reason not to eliminate the ACA at all, a completely irresponsible and foolish position, but it’s also a rather delusional position to take, since the ACA is spiraling toward collapse.

Humana, one of the nation’s largest health insurers, announced on Tuesday that it now plans to pull out of the ObamaCare exchanges in all 11 states in which it operates, citing, according to reports, unbalanced risk in the customer population. Humana covers roughly 150,000 people through the exchanges.

Humana’s decision, which came just shortly after the announcement that a $34 billion merger plan with Aetna had been called off following a court’s decision to block the plan, is another in a long line of recent ObamaCare exchange pull-outs. In 2016, Aetna and UnitedHealth announced the end of their involvement in most of the ACA exchanges in 2017. Other, smaller insurers also backed out of the exchanges. As a result, an estimated 1.4 million people in 32 states were forced to find new health insurance providers or plans.

Regardless of what Congress does, ObamaCare is dying. Centrist Republicans should stop worrying about politics and should instead prioritize the importance of pulling the plug on this destructive and costly law.

Justin Haskins is executive editor of The Heartland Institute and editor-in-chief of the New Revere Daily Press.

The views expressed by contributors are their own and are not the views of The Hill.