GOP Shouldn't Squander Trump's Revival of Obamacare Debate

Former President Donald Trump recently revealed he is "seriously looking at alternatives" to Obamacare.

As he put it in a post on Truth Social, "[t]he cost of Obamacare is out of control, plus, it's not good Healthcare."

Those comments should have come as good news to lawmakers looking to reduce the role of government in healthcare.

And yet, rather than affirming this call to replace the 2010 health law, many Republicans have tried to brush off Trump's remarks.

For example, Sen. Thom Tillis, R-N.C., insisted that "[w]e've gotten so far down the road now that it's almost technically impossible to do that."

Trump, of course, is right.

Obamacare is as broken today as it was during the height of the "repeal and replace" effort of 2017. If the GOP takes back control of Washington in 2024, it must do something about this nearly 14-year-old law.

It's hard to argue with Trump's diagnosis of Obamacare's flaws. First, there's the issue of cost. Between 2013 --- the year before Obamacare's market regulations took effect --- and 2019, average individual monthly premiums more than doubled from $244 to $558.

That's quite an achievement for a law dubbed "the Affordable Care Act."

These skyrocketing costs are mostly the result of Obamacare's heavy-handed rules and regulations. Among these is the requirement that all health plans cover a list of ten "essential health benefits," which includes everything from pediatric dental care to substance abuse services.

Patients who neither want nor need such benefits have no choice but to pay for them, since simpler or more tailored plan designs are now against the law.

Democrats have tried to mask these extravagant premiums through increasingly generous federal subsidies, but these efforts have merely shifted costs onto taxpayers.

The enhanced premium tax credits signed into law by President Joe Biden last year are expected to cost the federal government roughly $30 billion a year.

As for Trump's contention that Obamacare is "bad healthcare," this too is plain to see.

How else to explain why 4.4 million Americans who qualify for subsidized insurance through the state and federal marketplaces continue to go without coverage rather than settle for an exchange plan?

Given the unequivocal mess Obamacare has made, advancing alternatives to the law isn't just reasonable — it's necessary.

Clearly, there are many congressional Republicans who aren't spoiling for a fight on Obamacare.

But that fight is coming whether they want it or not.

Biden's enhanced premium tax credits are set to expire in 2025, at which point lawmakers will be forced to either extend those subsidies, find a different way to make coverage more affordable, or some combination of the two.

And while wholesale repeal of Obamacare may not be feasible, this impending showdown does offer a chance for Republicans to roll back some of the most dangerous aspects of the law while advancing some market-oriented reforms.

For example, one could imagine Republicans agreeing to extend some of the enhanced premium subsidies in exchange for a significant expansion of health savings accounts — say, by raising annual contribution limits and allowing Medicare beneficiaries to contribute to such accounts.

Or they might demand that Medicaid transition to a block-grant financing structure, in which states get a fixed amount of federal money for the program each year instead of the open-ended funding stream they currently enjoy.

Reforms that make it easier for patients to access short-term, limited-duration health plans could also be in the offing. Since these plans aren't subject to Obamacare's premium-inflating regulations, they tend to cost a fraction of what exchange coverage does.

Wholesale repeal of Obamacare may not be possible in the near future. But the GOP will soon have a chance to dramatically reshape our health sector in ways that blunt the worst consequences of this disastrous health law.

By reopening the debate over Obamacare, Trump is setting the stage for this upcoming legislative battle, and giving Republicans in Congress an opportunity they'd do well not to squander.

Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is "False Premise, False Promise: The Disastrous Reality of Medicare for All," (Encounter Books 2020). Follow her on Twitter @sallypipes. Read Sally Pipes' Reports — More Here.