On Election Day, Democrats won a majority of seats in the U.S. House of Representatives, which means it will be nearly impossible for federal lawmakers on either side of the aisle to replace the Affordable Care Act in the next two years. However, that doesn’t mean important health care reforms can’t be achieved.
Obamacare has been a disaster, plain and simple. Among its highlights: unaffordable premiums, skyrocketing deductibles, huge increases in Medicaid rolls, and fewer options for health care providers. Not only has Obamacare been outrageously expensive and conflict-ridden, it’s also on the road to financial collapse. Because many young, healthy Americans have chosen not to enroll in Obamacare due to its high costs, older and sicker people are overly represented in exchanges, driving up costs even more and creating a death spiral for this massive government boondoggle.
Although almost all Democrats initially supported Obamacare, many on the left no longer favor the program. However, this does not mean they have reversed course on their health care philosophy. Rather than embrace free-market solutions to America’s health insurance crisis, most Democrats want to give even more power to the very same people that screwed up the health insurance industry in the first place: government bureaucrats and so-called “experts” like Obamacare architect Jonathan “the stupidity of the American voter … was really critical for the thing to pass” Gruber.
In fact, a majority of Democrats now support some form of Sen. Bernie Sanders’ (I-Vermont) “Medicare for All” plan — which could cost an alarming $32 trillion over 10 years, according to a report by the Mercatus Center.
Despite Democrats’ growing affection for Medicare for All, there’s no chance the Republican-led Senate will ever go along with such a radical proposal. However, the very fact that so many Democrats have lost faith in Obamacare may open the door for a health care reform renaissance at the state level.
The Trump administration has already embraced federalism by encouraging state lawmakers in both parties to use Section 1332 State Innovation Waivers to enact short-term, limited-duration health plans; Medicaid work requirements; and association health plans, among other policies. And the presence of a divided Congress makes it far more likely the Trump administration, which has repeatedly said it’s eager to help lower health insurance costs, will issue even more state-friendly health care rule changes.
In the wake of the election, Trump administration officials have started to advocate for state-based reforms. For instance, on November 13, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma tweeted, “Starting in April of last year, the Trump administration called for a new era of state-federal partnership in #Medicaid. I believe a great deal of progress has been made on that front already.”
Among the reforms Verma has thus far indicated CMS will roll out is a proposal to make it easier for Medicaid and Medicare recipients to receive telehealth services.
Echoing Verma’s statement, Department of Health and Human Services Secretary Alex Azar tweeted, “With a spirit of partnership between federal and state governments, we have tremendous potential to confront the serious health challenges our country faces.”
Azar’s agency, working in coordination with CMS, could potentially unbridle state-based health care reforms that would dramatically reduce health care costs while simultaneously increasing access to quality care. Just to name a few possibilities, HHS could expand the breadth of services eligible for payments with health savings accounts, as well as issue rule changes that would further degrade Obamacare’s centralized, one-size-fits-all approach.
Obamacare has become the lemon on the corner of the lot that few lawmakers want to test drive, much less buy, but thanks to the Trump administration’s push for federalism in health care, important reform options remain.