Republicare is dead; Obamacare yet lives.
The Republican bill to replace Obamacare — the American Health Care Act (AHCA), better known as Republicare — was withdrawn after the House Republican leadership realized that they did not have enough Republican votes to pass it. Too many Republicans wanted a simple bill to repeal Obamacare and not replace it with anything.
One would think that repealing Obamacare would have been the first order of business for the Republican-controlled Congress once Trump was sworn in. After all, Republicans have spent the last seven years since Obamacare was passed denouncing the law, campaigning on promises to repeal it, airing more than $235 million in ads attacking the law, and staging more than 50 high-profile votes in the House to repeal it.
It turns out that “some GOP legislators are saying that the political assault on Obamacare was an exercise in cynical politics, and that an outright repeal was never on the table.” Rep. Pat Meehan (R-Penn.), who once pledged to “repeal, defund, delay, and dismantle Obamacare,” recently conceded that Obamacare repeal efforts were a sham:
Asked if the years of votes against the ACA were simply “ceremonial,” since Republicans knew that any serious repeal bill would be vetoed by President Barack Obama, Meehan responded “yes.” “I don’t think anyone would quarrel with the idea that they were largely position votes,” Meehan continued. “They were as political as they were anything else….”
Although House Speaker Paul Ryan pronounced Obamacare the “law of the land” and maintained that “we’re going to be living with Obamacare for the foreseeable future,” some Republicans are not giving up on the fight to repeal Obama’s signature health-care law in its entirety. On the same day that the AHCA was withdraw, Rep. Mo Brooks (R-Ala.), a member of the House Freedom Caucus, who says he cast a “no” vote on “a horrible replacement bill,” introduced a simple one-sentence bill to repeal Obamacare: “Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted.”
But even if Brooks’s bill to repeal Obamacare is passed by the House and Senate and signed into law by Donald Trump, it must still be said that repealing Obamacare is not enough.
Even if the Obamacare tax increases are rescinded, even if the health-insurance exchanges are done away with, even if the federal subsidies for the purchase of health insurance are ended, even if the “reforms” to the health-care and health-insurance systems are repealed, even if the new requirements for insurance companies and policies are revoked, even if the Medicare expansion is rolled back, and even if the individual and employer mandates are eliminated — repealing Obamacare is still not enough.
Even if everything goes back the way it was before Obamacare was enacted, we would still have massive government intervention in health care and in the health-insurance industries.
In 2003, the Republican majority in Congress passed Bushcare, the Medicare Prescription Drug, Improvement, and Modernization Act. It was supported by all of the Republican leaders in both Houses of Congress and passed with overwhelming Republican support before it was signed into law by a Republican president, George W. Bush. This Republican version of health-care reform expanded Medicare beyond the wildest dreams of Lyndon Johnson’s Great Society.
In 1997, the Republican-controlled Congress created the State Children’s Health Insurance Program (SCHIP), a partnership between federal and state governments that provides federally funded health insurance to children in families with incomes too high to qualify for Medicaid. The program has been reauthorized with Republican support ever since then.
In 1986, Ronald Reagan signed into law a bill that was passed with the help of the Republican-controlled Senate called the Emergency Medical Treatment and Active Labor Act (EMTALA). It requires any hospital that participates in Medicare (virtually every hospital) to provide emergency care to anyone who needs it, regardless of his lack of insurance, immigration status, or ability to pay. It includes no reimbursement provisions.
In 1965, Lyndon Johnson signed into law the Social Security Amendments of 1965 that created the nation’s first public health programs: Medicare and Medicaid. Medicare is government-funded health care for Americans 65 years old and older and for those who are permanently disabled, have renal disease, or ALS. It covers more than 55 million Americans. Medicaid is government-funded health care for poor Americans of any age and people with certain disabilities. It covers about 70 million Americans. Medicare and Medicaid are the second- and third-largest federal domestic programs, after Social Security.
Admittedly, it was a Democratic president and a Democratic-controlled Congress that enacted Medicare and Medicaid. But did Reagan and the Republican-controlled Senate he had for six years do anything to roll back those programs? Of course not. And the payroll tax that partially funds Medicare more than doubled during the Reagan years. Did the Republicans in Congress do anything to roll back those programs when they had a majority in both Houses for six years under Bill Clinton? Of course not. Did Republicans in Congress do anything to roll them back when they controlled the Congress for more than four years under the Republican president George W. Bush? Of course not. So Republicans are as much to blame for these programs as Democrats.
And aside from the Medicare Prescription Drug, Improvement, and Modernization Act; SCHIP; EMTALA; Medicare; and Medicaid, there were and are a myriad of federal laws, mandates, rules, regulations, requirements, initiatives, guidelines, restrictions, and programs that interfere with the health insurance and health-care markets.
Repealing Obamacare is not enough because it is not a legitimate purpose of government to fund medical treatment, medical research, community health centers, clinical trials, family planning, HIV/AIDS prevention initiatives, or vaccination programs; issue nutrition guidelines, restrict the sale of medical devices, mandatory insurance coverages, have medical-licensing laws, restrict the sale of organs, have medical-record requirements, subsidize anyone’s health insurance, or issue mandates and regulations regarding physicians, dentists, nurses, midwives, psychiatrists, psychologists, hospitals, pharmacists, insurance companies, medical schools, nursing homes, or drug companies.
Repealing Obamacare is not enough because there is nothing in the Constitution that authorizes the federal government to have Medicare, Medicaid, SCHIP, the National Institutes of Health, federal laboratories, the FDA, the Department of Health and Human Services, or federal databases of American’s medical records.
Repealing Obamacare is not enough because health care is not a right. Health care is a service just like lawn mowing, car washing, pest control, and hair cutting. It is an important service, but it is still a service that can and should be provided on the free market like any other service. No one is entitled to health care that is provided at the expense of another. No American should be forced to pay for the health care of any other American — regardless of how poor or sick that other American is.
Obamacare should be repealed. But repealing Obamacare is not enough for those who prefer to live in a free society with a government limited to its constitutional functions.