President Trump has endorsed a bill to repeal and replace Obamacare. His plan, called the American Health Care Act, is described as the first of three immediate steps occurring to end this nightmare. Remember, Obamacare was implemented over several bills, with tons of executive overreach. Administrative corrections and legislation clearing the 60-vote Senate threshold must follow. For this bill, we need 51.
I’ll be frank — I’m not crazy about it. I wanted to like it, especially after hearing from Obamacare’s victims: prices skyrocketing, premiums rising, plans closing, coverage decreasing. I wanted to like it, because the thought of government forcing people to buy anything — much less health insurance — disgusts me. We know Obamacare is a wet-blanket over our economy, smothering the job-creating ambition of small businesses. I wanted to love it, I just didn’t.
We should be going bolder. We should get the federal government out of health care completely, not just diminish its role.
Then I remembered Tom. I met him at Waffle House. His hashbrowns were smothered and covered; his question was direct: “How will you decide which way to vote on stuff?” he asked while wiping ketchup from his mustache.
I told him I’d vote for bills that got power out of Washington — and against ones that didn’t. He grumbled on the way out, “Don’t lie to me” — and took a bumper sticker.
There is no debate that the American Health Care Act means less power for Washington. Specifically, under Trump’s plan, the federal government cannot provide taxpayer dollars to Planned Parenthood; enroll illegal aliens in health care entitlements — only to check their status later; tax people for not buying government-mandated health insurance; stop associations or groups from forming their own risk pools; punish businesses for hiring more employees; or force you away from your doctor or plan.
It also reduces the deficit by $337 billion over 10 years and constitutes $1 trillion in tax cuts by repealing 14 Obamacare taxes. These are big conservative wins.
With several key changes, this bill would be much bolder. It wouldn’t be perfect — but better.
First, there should be a work requirement. Able-bodied, childless adults who can work and choose not to should not expect America to borrow money from China to pay for their health care. Everyone can contribute to society — if not through a job or skills enhancement, by volunteering. This will help curb costs and engage all Americans in productivity.
Second, Medicaid can’t keep expanding. The bill currently takes the position that Medicaid can expand for two-and-a-half more years before it is ultimately contracted. Already, 1 in 4 Americans is on Medicaid. This is like hoping to lose weight by planning to diet in two-and-a-half years — and eating everything in sight until then.
Finally, states should be totally in charge of Medicaid. The federal government has proven an incompetent operator of the Medicaid program. We need 50 laboratories of democracy, totally unconstrained, innovating for better health care and lower costs. Some states will get it right; others will copy.
It’s easy to vote “no” and just blame others for not bending to my will. It’s harder to persuade others that the conservative way is the better way.
I serve on the Budget Committee. Earlier this week, my conservative colleagues and I offered Budgetary “Motions of Instruction” to address these issues. Thankfully, they passed, meaning the Rules Committee can accept our amendments to drain this swamp even lower.
I voted in favor of President Trump’s plan to keep the conversation going — to keep the legislative process focused on free-market, patient-centered healthcare. Giving up or accepting failure simply because the initial version of this bill underwhelms is not an option. The American people won’t give us unlimited bites at the apple — it’s time to get healthcare reform right, or be stuck with the disaster that is Obamacare forever.
I owe Tom a strong fight to make President Trump’s bill far better. I also owe him whatever vote gives him more power, and Washington less. Let’s keep working.
Matt Gaetz is the U.S. Representative for Florida’s 1st Congressional District, stretching from Pensacola to Holmes County.
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