Congress and the president must take the lead in fixing ObamaCare

Congress and the president must take the lead in fixing ObamaCare
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Members of Congress have famously failed to fulfill campaign promises to repair or replace the Affordable Care Act. Those unfulfilled promises have left states looking for new ways to fix their broken health-care systems. As Congress hems and haws on health care reform, states have been lining up to ask the Trump administration for administrative relief under the ACA’s innovation and Medicaid 1115 waivers.

Too often, executive branch offices have denied or unduly delayed those requests. And now the federal judiciary has joined Congress and the administration in blocking states from enacting commonsense health care reforms. A recent decision by U.S. District Court Judge James Boasberg highlights the risks of relying solely on waiver requests and executive branch leniency, and it casts much of the waiver process into legal limbo.

Boasberg’s ruling has stopped Kentucky from implementing its Medicaid waiver program for able-bodied beneficiaries, which the Centers for Medicare and Medicaid had already approved. The key component of Kentucky’s waiver request was a work and community engagement requirement for able-bodied Medicaid recipients, the first to receive federal approval. The Trump administration has encouraged such requirements, and 10 other states, including Ohio, have already filed similar waiver requests with Washington. Michigan is now preparing its own request, and others are doing the same.


Fortunately, the court’s ruling did not object directly to Kentucky’s community engagement requirements. Instead, Boasberg found that the Health and Human Services secretary had failed adequately to address how Kentucky’s proposed requirements would “furnish medical assistance to its citizens.” Kentucky’s waiver request, barring appeal, will, therefore, go back to CMS for further consideration.

It remains an open question whether CMS will appeal the court’s decision, revisit Kentucky’s proposal and try again, or stop approving waiver applications all together, and that question has thrown the waiver process into uncertainty and turmoil. Other states may soon abandon entirely their attempts to seek waivers for work requirements, or at least until Kentucky’s case has been resolved.

After Boasberg’s ruling, the path forward for states seeking commonsense reforms to broken health-care systems has become even more treacherous, and citizens will suffer for it.

The Trump administration must send a loud and clear message: It remains staunchly committed to supporting state efforts to achieve better, more innovative, and more efficient outcomes while preserving Medicaid as a viable safety net for our most vulnerable patients.

More importantly, the court’s decision and the chaos that will now ensue underscore the urgent need for Congress to act and work with the administration to find remedies for our ailing health-care system. Medicaid waivers can and should be used more effectively. But they are no long-term solution to the looming health care crisis that Congress must now fix.

Rea S. Hederman Jr. is vice president of policy at The Buckeye Institute in Ohio, an independent free-market research institute. Lindsay Boyd Killen is vice president for strategic outreach and communications at the Mackinac Center for Public Policy in Michigan, a research and educational institute.