Health Care: Is It Time to Replace the Majority Leader?

On July 30 on "Fox News Sunday" (video and transcript), House Minority Leader Nancy Pelosi said this:

[T]he Affordable Care Act is something… that said no free riders. Everybody has to have insurance, so that if your neighbor's not buying insurance and you are, you are paying more because he or she is not. So, this is about enlarging the pool, making it healthier, younger… you have to have a big pool… the more people who are involved in it, the lower the costs are for everyone.

The Affordable Care Act did in fact increase the number in the pool that is the individual market, the “Non-Group” market, which is the pool Pelosi was talking about. By 2015, the individual market had increased by around 8 million enrollees, an uptick of close to 58 percent. But costs are still going up, and steeply. It would appear that there is something amiss with Pelosi’s pricing theory. 

Pelosi’s position that “you are paying more” because “your neighbor’s not buying insurance” is just wacky. It’s tantamount to forbidding airlines to charge more for obese passengers who require two seats. Pelosi would expect the regular-sized passengers to gladly pay more for their tickets so that lardaceous flyers won’t have pay twice. If you are indeed “paying more” for health insurance, it’s because of the high probability that you’ll be getting more, and costing your insurer more.

Pelosi must be amazed at the high prices for Super Bowl tickets. After all, there are certainly lots of people in that pool; why aren’t their prices lower? Pelosi might deal with the problem of Super Bowl ticket demand with price controls, or maybe by increasing the number of seats in the arena. But, in keeping with the ACA, she’d probably prefer to enact tax penalties for those who buy tickets.

Actually, you were never “paying more.” That’s because you weren’t paying at all. You have “pre-existing conditions” which, in a business that works by assessing risk, made you uninsurable. And now that Nancy Pelosi has mandated that you be insured, you’re still paying precious little because taxpayers are picking up most of your tab. So if the problem was that you’re “paying more,” then the ACA was a solution to a problem that would emerge only after the ACA dumped the expensive, gravely ill, uninsurable patients into the smallest market.

Also, how are people “free riders” if they’re not using healthcare? Healthy people aren’t costing insurance companies anything. A better case for “free ridership” could be made for the sick folks using welfare, like Medicaid, which is “free,” (at least for the users). The real reason Pelosi calls non-buyers of health insurance “free riders” is because they’re not paying into her system.

One does wish that Pelosi could finally get around to reading her bill, because the ACA does not dictate that “everybody has to have insurance.” Rather than a mandate on everybody, the ACA dictates that only those who have a federal individual income tax liability must have health insurance. If one isn’t required to file an income tax return, then one needn’t have health insurance. By 2015, the uninsured still outnumbered those in the Non-Group market, which remained the tiniest cohort other than Veteran’s Affairs.

One of the big problems with the ACA, as we’ve just seen, was the rhetoric used to sell it. But Republicans have created their own rhetorical trap in their efforts to undo the ACA. Mrs. Pelosi even said that the only thing the GOP’s slogan has going for it is alliteration; “repeal and supplant” doesn’t quite roll off the tongue as pleasingly as “repeal and replace.” One way out of their rhetorical trap is for repeal holdouts to answer this question: What in the ACA do you want to “retain”?

For conservatives, libertarians, and conservatarians who think that Congress should repeal ObamaCare in its entirety, that is the question: is there anything in the ACA worth keeping? The holdouts don’t want to take away coverage for desperate folks with pre-existing conditions; they “didn’t come to Washington to hurt people.” Fine, let’s accommodate the holdouts by retaining coverage for these folks.

But put them into Medicaid or some special new program, because their presence in the individual market through the subsidy program is what’s causing prices to soar. The subsidy program is one of the features of ObamaCare that should not be retained. Yet, some Republicans want to keep some version of it. If one can’t afford to pay one’s premiums, deductibles, and copays, then one needs to accept charity and accept being on a public program.

What Republicans should avoid at all costs is supplanting ObamaCare with their own version of a “comprehensive” system. There’s not enough time for that, and it’s a bad idea anyway. Republicans should avoid the mistakes of Democrats and aim for a modest bill, to wit: 1.) total repeal of the ACA, 2.) repeal of the parts of the McCarran-Ferguson Act that prevent selling health insurance across state lines, and 3.) federal funding for uninsurable patients with pre-existing conditions, but not in the tiny individual market.

Of course, such a bill would not fix everything in the healthcare system, but it is a necessary first step that makes it possible to address the other problems. So there will need to be additional legislation. But the second item (repeal of McCarran) is a necessary step in creating a free market for health insurance; which would bring the private sector closer to being truly private again.

Senate Majority Leader Mitch McConnell was terrific when he tabled Obama’s final Supreme Court nominee, allowing Neil Gorsuch to ascend to the Supreme Court. conservatives are very thankful to McConnell for exercising such steely resolve. But is McConnell now willing to do what’s necessary to repeal ObamaCare in its entirety: i.e. the “nuclear option” of ignoring the legislative filibuster?

The American people don’t give a fig about the legislative filibuster; they want relief. If McConnell is more interested in Senate rules and traditions than in giving American businesses and individuals some relief from stupid laws, then we need to find a new Majority Leader. I think McConnell’s fellow Kentuckian Rand Paul might fill the bill, or perhaps Mike Lee or Ben Sasse.

The “loyal opposition” is unhinged. Democrats are still unable to get over the 2016 election. Being indignant and angry is going to be their default position until they are taken off the board. If Democrats had any decency they would have repealed the ACA themselves after the ruling in NFIB v. Sebelius. If Democrats retake the Senate in 2018, their first order of business will be to end the filibuster. The GOP needs a Majority Leader less concerned about the institutional niceties of the Senate than about doing the people’s business.

The problem is not Trump; the problem is Congress. One wonders if the swamp denizens that make up much of the congressional Republican majority are more intent on making Trump a “one-term president” than in doing right by the people. The GOP actually seems rather blasé about holding onto power. On July 21 in “The Looming Republican Disgrace,” a must-read column at National Review, Rich Lowry put it succinctly: “A majority is a terrible thing to waste.”

The only way congressional Republicans can redeem themselves is by doing what they promised. The way to keep their promise is with a simple modest repeal bill of the kind just proposed. There’s still enough time for redemption.

Jon N. Hall of Ultracon Opinion is a programmer/analyst from Kansas City. 

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