Republicans have kicked off their ObamaCare “repeal and replace” campaign, but there will likely be neither repeal nor replace unless Republicans control both Congress and the White House, and that’s 2012 at best — if then. However, by taking over only one house of Congress opponents can dramatically lower the unsustainable cost of ObamaCare by refusing to fund its worst elements. Here’s a few suggestions.
Reduce Medicaid eligibility. Historically, states have varied widely on Medicaid eligibility, with some setting the threshold significantly below the federal poverty level (FPL). ObamaCare sets a nationwide eligibility threshold at 133 percent, which increases the number of people in the government-run program by an additional estimated 15 million by 2019. Funding Medicaid eligibility only up to 100 percent of FPL would dramatically lower its cost. Medicaid was created for the poor (i.e., those under the poverty level) and it should remain that way.
Reduce the subsidy level. For those with incomes above 133 percent of FPL, ObamaCare provides a sliding-scale subsidy for purchasing health insurance for up to 400 percent of FPL. That’s a whopping $88,000 a year for a family of four today, and may be nudging 100 grand by 2014 when the subsidy goes into effect. Many of these families can easily afford at least basic coverage. Setting subsidies at that level is more about making most Americans dependent on government than improving access to affordable coverage. The level should be reduced to a maximum of 200 percent or 250 percent of FPL.
Defund new agencies and commissions. The legislation creates more than 100 new agencies and boards and commissions. Most of these efforts will prove fertile ground for mischief making — especially the new Independent Payment Advisory Board (IPAB), which has significant new powers to impose price controls on Medicare. Congress can refuse to fund most or all of these new boards. No money, no mischief.
None of these proposals fixes ObamaCare. And there are lots of other options that would make the system better, but would likely be vetoed by the president. But resistance provides opponents an opportunity to continue to explain all the problems with ObamaCare.
While “repeal and replace” is a very politically appealing mantra, “debunk and defund” may be the best short-term option.