President Donald Trump golfed with Sen. Rand Paul (R-KY) and budget director Mick Mulvaney on Sunday to discuss a potential Obamacare replacement plan. Paul sounded positive about the discussion.
"I continue to be very optimistic that we are getting closer and closer to an agreement on replacing Obamacare," Paul told the Associated Press.
It remains to be seen if Trump and the Republican Congress have the spine to truly repeal Obamacare, but if they do, here are five ways they can do it.
1. Pass a clean repeal bill. This the most obvious way they can repeal Obamacare: the Republicans could repeal most if not all of Obamacare through the reconciliations process, which should make repealing the healthcare law fairly easy. However, such a bill was proposed by Rep. Mo Brooks (R-Ala.) at the end of March and it went nowhere, suggesting that the Republicans won't be passing a clean repeal bill anytime soon. There are other ways they could go about dismantling Obamacare, however.
2. Kill the most onerous aspects of the law. The regulations that are primarily responsible for the soaring rise in premiums are the pre-existing conditions mandate and the requirement for insurers to charge the same premiums to consumers regardless of their health status. At the very least, these regulations along with the mandates and taxes that fund them can and should be repealed in a reconciliations bill.
3. Defund it. If nothing else, congressional Republicans can gut the enforcement of Obamacare by depriving the law of funding, thus inhibiting the regulatory state from enforcing current regulations and spitting out further regulations as well as slow the law's entitlement spending. Defunding the law would put a pause on the Obamacare death spiral and give Republicans more time to draft up a viable repeal and replacement law.
Granted, a number of congressional Republicans would likely be reluctant to defund Obamacare after the 2013 government shutdown, but the shutdown did not harm the Republican Party's election prospects in the 2014 midterm elections. Additionally, with Republican control of both Houses of Congress and the presidency, the blame for a potential shutdown would fall solely on the shoulders of the Democrats. That's why Trump is reportedly fine with a shutdown if Congress doesn't approve of funding his wall; he should have the same approach for defunding Obamacare.
4. Alter the law administratively.
Cleveland.com listed some ways in which Price could cripple Obamacare from his perch as Health and Human Services Secretary (HHS):
- Refusing to penalize those who don't buy health insurance.
- Providing waivers from Obamacare to states that can design their own programs.
- Allowing states to add work requirements or premiums to Medicaid.
- Modifying the services that insurers are forced to cover.
- Dropping an appeals lawsuit that would result in insurance companies losing reimbursement funds in federal tax dollars, resulting in more insurers leaving Obamacare.
Additionally, Daniel Horowitz notes in Conservative Review that Price can "get rid of any cost-sharing subsidies and risk corridor bailouts for insurance companies," which would "force insurers to utilize the lifting of regulations to lower prices and actually compete for business rather than relying on subsidies."
5. Put forward a replacement plan that embraces the free market. Such a plan should include purchasing insurance across state lines, expanding health savings accounts and tort reform among other ideas, as Horowitz lays out here.
Uniting the party behind a free-market plan and then sending out young, articulate congressional conservatives to explain to the public how the plan empowers consumers and individual liberty would ultimately be the best way to ensure that Obamacare is repealed and replaced. However, it doesn't seem like congressional Republicans are up for the task.