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Republicare

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The Patient Protection and Affordable Care Act, otherwise known as the PPACA or Obamacare, was signed into law by Barack Obama on March 23, 2010, without a single Republican vote.

It was fitting that Obamacare’s first requirement was a new tax, since the new law was in large part just a collection of tax increases masquerading as a health-care law. And in addition to its other new taxes, Obamacare increased taxes on wages and investment income and decreased deductions for medical expenses.

Aside from its tax provisions, Obamacare includes many “reforms” to the health-care and health-insurance systems. They include the expansion of Medicare, changes to the Medicare payment system, the creation of health-insurance exchanges, federal subsidies for the purchase of health insurance, and new requirements for insurance companies and policies. The worst things about Obamacare are, of course, its mandates that all employers with 50 or more employees must offer health insurance or pay a penalty, and that every American not covered by Medicaid, Medicare, or health insurance must purchase health insurance or pay a penalty.

After the Republicans regained control of the U.S. House of Representatives in the 2010 midterm elections they voted to repeal Obamacare many, many times. But because the Democrats controlled the Senate until the 2014 midterm elections, their actions were all symbolic until then. Once full Republican control of Congress was achieved, beginning with the 114th Congress in January 2015, one would have thought that the first order of business would have been to pass and submit to Obama a bill to repeal Obamacare. That did not happen for a full year. The House passed a bill (H.R.3762) on October 23, 2015 — the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015 — to repeal Obamacare. It was amended by the Senate and passed on December 3, 2015. The House agreed to the Senate amendment on January 6, 2016, and the bill was presented to Obama the next day. As expected, he vetoed it, and Congress was not able to override the veto. Obama maintained that the bill would undo the “significant progress we have made in improving health care in America.” He claimed, “This legislation would cost millions of hard-working middle-class families the security of affordable health coverage they deserve. Reliable health-care coverage would no longer be a right for everyone: it would return to being a privilege for a few.” No other bills to repeal Obamacare were ever presented to him.

This is all understandable, since there was no way that Obama would ever have approved legislation to repeal his signature health-care law. Republican attempts to do so with Obama in the White House were all just political theater.

But with the election of Donald Trump as president, Republicans gained absolute control of the government. They could have had a bill already drafted to repeal Obamacare and put it on his desk his first day in office. It could have been just a one-sentence bill: “The Patient Protection and Affordable Care Act (PL 111-148, 124 Stat. 119 through 124 Stat. 1025) is hereby repealed.” No bill to repeal Obamacare was ever presented to Trump, let alone passed. Only nine bills have been presented to him since he was sworn in on January 20. Eight have been signed into law and one is pending his approval.

Why is it that Republicans last year passed a bill to repeal Obamacare and sent it to Obama when they knew he would certainly veto it, but now with a Republican in the White House, they have yet to pass a similar bill and send it to him?

Even worse, instead of simply repealing Obamacare and returning things to just the way they were before it was passed, Republicans have introduced a replacement for Obamacare they call the American Health Care Act (AHCA).

Just call it Republicare.

The American Health Care Act “dismantles the Obamacare taxes” and eliminates “the individual and employer mandate penalties.” That is good. However, it continues to “prohibit health insurers from denying coverage or charging more money to patients based on pre-existing conditions” and to allow “dependents to continue staying on their parents’ plan until they are 26.” That is not so good. And it modernizes and strengthens Medicaid “by transitioning to a ‘per capita allotment’ so states can better serve the patients most in need” and helps “Americans access affordable, quality health care by providing a monthly tax credit — between $2,000 and $14,000 a year — for low- and middle-income individuals and families who don’t receive insurance through work or a government program.” That is bad.

The introduction of Republicare should come as no surprise to anyone, and for two reasons.

First of all, it was a Republican-controlled Congress in 1997 that created the State Children’s Health Insurance Program (SCHIP) to provide federally funded health insurance to children in families with incomes too high to qualify for Medicaid. It was a Republican-controlled Congress that expanded Medicare beyond Lyndon Johnson’s wildest dreams with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 that was signed into law by the Republican president George W. Bush. And it was conservative Republicans in the House who issued a “Pledge to America” on the eve of the 2010 midterm elections that maintained that “health care should be accessible for all, regardless of pre-existing conditions or past illnesses.” They expressed a desire to “make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a pre-existing condition, eliminate annual and lifetime spending caps, and prevent insurers from dropping your coverage just because you get sick.”

And second, Republicans don’t believe in the free market when it comes to health care. Although they talk about their desire for a smaller, less-intrusive government with fewer regulations and the glories of the free market, they believe nothing of the kind when it comes to the subject of medicine. They differ from Democrats only on the details of the federal laws, rules, regulations, and mandates regarding health care and health insurance. The Republican argument against Obamacare was never about advancing medical freedom. They may not believe that the federal government should force Americans to purchase health insurance for themselves (the Obamacare mandate), but they certainly do believe in forcing some Americans to pay for the health insurance or health care of other Americans through socialized medicine programs such as Medicare and Medicaid.

Real medical freedom includes the complete deregulation of the health-insurance industry and a free market in ambulance services, medical devices, medical schools, drugs, and body organs.

Real medical freedom means no government vaccination programs, no medical-licensing laws, no Medicaid, no Medicare, no SCHIP, no government grants for medical research, no government funding of clinical trials, no government laboratories, and no Department of Health and Human Services.

In short, Obamacare should be repealed and replaced with nothing, and all federal laws, mandates, programs, and regulations related to health care, health insurance, hospitals, physicians, and drugs should be eliminated.