Speaker Ryan in WSJ: Keeping Our Promise to Repeal Obamacare

NOTE: "By passing the American Health Care Act, we will deliver on our promise to repeal and replace ObamaCare. By applying conservative ideas and principles, we will remake our health-care system for generations. The responsibility is ours, and so is the opportunity."

Keeping Our Promise to Repeal and Replace Obamacare

The Wall Street Journal

March 22, 2017

http://spkrryan.us/2neOPXi

The election of Donald Trump and a Republican Congress provides an opportunity: We can immediately halt the leftward drift of American social policy, while renewing prosperity through market-based, state-driven solutions that empower people instead of bureaucrats. This is the stuff of conservative dreams. But it will become reality only if Republicans keep the promises we have made.

That's what the American Health Care Act is all about. It is the boldest and most conservative health-care legislation to come before Congress in decades. Bold because it dismantles the progressive health-care experiment and replaces it with a dynamic, patient-centered system. Conservative because it applies America's founding principles--freedom, free enterprise and federalism--to the problems of the day.

Repeal of ObamaCare must happen, and urgently--not because of any ideology but because American families are already paying the price of the law's collapse. The average premium for a midlevel ObamaCare policy rose 25% this year. One out of three counties now have only a single insurance provider to choose from. This trend will only worsen: Humana has announced it will not offer coverage in the ObamaCare marketplace for 2018. Others are threatening to withdraw. As the CEO of Aetna said last month, the individual market is in a death spiral.

Achieving this goal will require a three-pronged approach: Use the budget reconciliation process to repeal ObamaCare and replace it with the foundation for a patient-centered system. Take administrative action through the Department of Health and Human Services to further deregulate the market. And draft additional legislation that we cannot pass through the reconciliation process.

The American Health Care Act is the linchpin. It is modeled on legislation introduced during numerous Congresses by Tom Price, now the secretary of health and human services. It reflects decades of policy making by conservative scholars and organizations.

The bill effectively guts ObamaCare--all its taxes, mandates and spending. It initiates a stable transition, without pulling the rug out from under anyone. And it puts in place good, conservative health-care policies.

First, the legislation gives control of Medicaid back to the states. This is--without question--the biggest entitlement reform in generations.

Medicaid is a critical lifeline for millions of Americans. Far from modernizing the program, ObamaCare threw more money at Medicaid and set it on an unsustainable course of growth. With all the bureaucracy and strings attached, too many doctors won't take Medicaid patients. It is a broken system.

Under our plan, for the first time, Medicaid spending will be capped, and states will have the option to receive a pure block grant. No two states are the same, and we believe if we let governors tailor benefits to the needs of their most vulnerable constituents, those people will get better care and Medicaid will be put on more stable financial footing.

Second, our bill equips state insurance markets to take care of people with pre-existing conditions without driving up costs for everyone else.

For decades, many states successfully served high-risk populations by segmenting them from the market into "risk pools" and directly subsidizing their coverage. This gave the most vulnerable Americans access to affordable coverage and stabilized markets, but without requiring higher premiums on healthier individuals to offset the costs. Wisconsin's program, which featured strong consumer protections and relatively low premiums, had the second-highest participation rate in the nation.

ObamaCare effectively did away with these programs. Instead the law relied on mandates to cross-subsidize care--with disastrous results. Our plan goes back to what works. The bill establishes a stability fund to help states set up their own risk pools and reinsurance mechanisms. These programs would provide direct support for people with pre-existing conditions, giving states more power to create dynamic markets for consumers. Ultimately this would lower costs for everyone else, so that more people can purchase a plan that meets their needs.

Third, our legislation expands health savings accounts, which a Republican Congress established during George W. Bush's presidency in 2003.

ObamaCare imposes strict limits on how you can spend your health-care dollars. This bill nearly doubles the allowable contributions to HSAs, making it easier to pay out-of-pocket costs. Giving people more purchasing power will create incentives to shop around, look for the best services, and demand more transparent prices--all of which helps lower costs.

Fourth, the bill equalizes the tax treatment of health care, addressing an unfairness conservatives have long sought to rectify.

Right now, the tax code discriminates against people who don't get health care from their jobs. It makes no sense that those who have insurance through work see a tax benefit, while those who don't, get nothing. Our bill would level the playing field by creating an age-based refundable tax credit. People who don't get coverage through work or a government program will be able to use this tax credit to buy the coverage they want.

Taken together, these ideas put the patient--not some bureaucrat--at the center of America's health-care system. Consumers get the freedom to choose the plan that meets their needs instead of Washington's mandates. Health insurers and providers compete against each other for customers, instead of jockeying for favoritism in Washington. This is American free enterprise at its finest, and Congress can put it to work by sending our bill to President Trump's desk.

Republicans have been waiting for this day, and working toward it, for seven years. In election after election, we promised to repeal and replace ObamaCare. When I became speaker, we pledged to turn those platitudes into bold ideas. We did that, with the "Better Way" plan put forward last year. Now we have the chance to make those ideas a reality.

To govern is to choose. An opposition party does not have to make decisions: It can demand everything and vote for nothing. But a governing party has a responsibility to follow through on the promises it has made.

By passing the American Health Care Act, we will deliver on our promise to repeal and replace ObamaCare. By applying conservative ideas and principles, we will remake our health-care system for generations. The responsibility is ours, and so is the opportunity.

Mr. Ryan is speaker of the House.

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