Judd Gregg: A GOP health-care escape hatch

To say that the Republican Congress’s handling of the repeal and replacement of ObamaCare is in a bit of disarray is an understatement.

The position of the party, as it now stands, is to allow ObamaCare to collapse, driving insurance premiums way up for lots of Americans, in many cases to the point of unaffordability.

In addition, costs to the federal government will go up dramatically and will be added to the deficit. 

{mosads}It is also likely that the entire health-care structure of the country will be put under extreme duress.

Its fundamental structure will then be called into question by those who want a nationalized system.

All this will be blamed, predictably, on Republicans.

This is a very bad position for the GOP to be in, both in terms of the substantive policy and in terms of the politics, as Republican members of Congress head into the 2018 election year.

The promise to repeal and replace ObamaCare was a big one, made by President Trump and Republicans who ran for Congress.

Failure to deliver on it is akin to an exercise in political self-immolation.

However, there is at least one viable escape hatch. 

Sen. Lamar Alexander (R-Tenn.) has proposed a patch that makes sense and would work. 

This idea does four basic things.  

It actually gives states the flexibility they need to address the delivery of health care and insurance.  

It avoids the collapse of the health insurance system.

It saves lots of money, in part by covering people who have catastrophic events.

And it undercuts the movement toward a single-payer, nationalized system, now euphemistically called “Medicare for all.”

The plan allows states, via a waiver, to actually write plans that work for them. 

They can, for example, replicate the Alaska approach, which sets up a state-based plan for the very sick, in the process reducing premiums for everyone else and paying for itself. 

This is what states like Minnesota and Iowa have been pleading for. Others would surely follow.

By expediting and extending waivers, the Alexander plan allows states to take the lead in getting the health care insurance system to function in a manner that benefits people.

Alexander calls this part of the plan, “Alaska for All.”

In addition, his proposal puts in place a national catastrophic insurance system, which means that millions of Americans — especially younger, working Americans — can finally buy the only insurance they really want, at an affordable price.

Further, if short-term funding of the current cost-sharing subsidies is cut off, as Trump has suggested is his default position in the absence of any formal repeal of ObamaCare, taxpayers will take a major hit.

Many parts of the country will have no health insurance available, as premiums jump dramatically.  

This will drive up federal costs on those policies that remain subsidized. It will add about $192 billion to the deficit over ten years, according to the Congressional Budget Office. 

In addition, there will numerous counties throughout the country where there will simply be no insurance coverage offered by any companies. 

This unraveling will be expensive and traumatic for many. And it will happen in the middle of the next Congressional election cycle.

Alexander’s proposal fixes this, through a two-year funding fix for cost-sharing.

There is another advantage, from a Republican perspective.

The Alexander initiative would allow insurance companies to offer coverage to millions of Americans who would otherwise have no options, or at best only one option.

In doing so, it would significantly undercut the case — made most prominently by Sen. Bernie Sanders (I-Vt.) — that the only way to fix the system is to have government take it over. 

“Medicare for all”  — otherwise known as a single-payer, nationalized system — would be a massive expansion of government. It would lead to a system that rations healthcare and undercuts innovation. It would be extremely expensive.

Nationalization is not an idea whose time has come. But the hands of its proponents will only be strengthened if Republicans do not fix the obvious problems that the failure to pass ‘repeal and replace’ has created.

The plan Alexander has come up with is not perfect. But, as should now be obvious to everyone, a perfect option does not exist.

What Republicans need now is a way to extricate themselves from the mess they have made of health care. 

It is fairly obvious that they cannot do this on their own. They need help. 

Alexander has crafted a plan that can attract some Democratic support, because it addresses the insurance-subsidy issue. 

It also gives states the flexibility to pursue real solutions, which Republicans should strongly support. 

As a by-product of his effort, he has created an escape hatch for the Republican Congress.

It is a proposal that is reasonable, bipartisan, saves money, and improves the opportunity for Americans to get quality healthcare insurance.  

Maybe someone should pass it.

Judd Gregg (R) is a former governor and three-term senator from New Hampshire who served as chairman and ranking member of the Senate Budget Committee, and as ranking member of the Senate Appropriations Foreign Operations subcommittee.

Tags Bernie Sanders Lamar Alexander

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