Republicans succeeded in repealing the individual mandate in the 2010 Affordable Care Act as part of the recent tax reform package, but a leading health care expert urges President Trump and members of Congress to do even more this year to bring financial relief to Americans saddled by high premiums and deductibles.
Galen Institute President Grace-Marie Turner has been on the front lines of the health care debate since before the Clinton administration attempted to give government a greater role in the sector in the 1990s. A fierce critic of the Affordable Care Act, better known as Obamacare, Turner is relishing how the individual mandate was sent to the scrap heap starting in 2019.
"The lovely irony is that the least popular provision of Obamacare was repealed in the tax bill. It's a bit of a touché to the Supreme Court," said Turner, noting that the court upheld the individual mandate as constitutional only if it was considered a tax.
Beyond the political and legal drama, Turner says the mandate improved nothing and was a major burden on people.
"It was ineffective. It was not doing what it needed to do. Health insurance was so expensive that it was driving people away from policies. Even with the tax penalties, people still found it was cheaper to pay the penalties than to buy this expensive coverage," said Turner.
"The people who were most affected by these penalties were people making less than $50,000 a year. It was backfiring from all perspectives," said Turner.
As a result of the mandate being ineffective, Turner does not expect costs to rise noticeably when people can refuse to buy health coverage with no penalty next year.
As Congress was voting the tax bill into law, President Trump suggested in comments to reporters that ending the individual mandate was akin to repealing Obamacare.
"The individual mandate is being repealed. When the individual mandate is being repealed, that means Obamacare is being repealed because they get their money from the individual mandate," said Trump on Dec. 20.
Turner says Trump is right to be excited over nixing one of the most burdensome aspects of Obamacare, but she says Trump and Republicans in Congress need to stay focused on even more health care policy changes.
"There's still lots of things on the books. We're spending hundreds of billions of dollars still on subsidies for people who may decide that they would rather purchase a different kind of coverage.
"All the rules and regulations are still on the books about the kind of coverage that we have to purchase, the expansion of Medicaid to the point where many states are finding they can't begin to afford their share of the costs of Medicaid; all of that is still on the books," said Turner.
And Turner know Trump is fully aware of this, as evidenced by his impending plan to offer expanded temporary health insurance. The Obama administration allowed only one-time, three-month temporary insurance policies for people between jobs or going through other transitions. The Trump plan will approve year-long policies that can be renewed year after year.
Trump is also expected to give the green light to association health plans through executive orders in the coming days. Turner say this will allow smaller companies that share a similar focus to band together so employees can be offered plans at competitive rates.
"Let's say you're a small contractor or you run a barber shop or a beauty parlor. You really can't afford to compete with the big guys in offering good health insurance to your workers. But if you were able to aggregate your policy with a lot of other similar businesses, then you can get the economies of scale. You could get more choices for your employees," said Turner.
She believes getting Washington bureaucrats out of health care also ought to be a top legislative priority.
"Give states a lot more authority in being able to approve the kind of health insurance policies that people want to buy, to allow the market to work to bring more players into the market. In many parts of the country, people are still only going to have a choice of only one plan. That's not a choice," said Turner.
Turner admits Republicans will be less motivated to address health reforms in 2018 since they repealed the mandate in the tax bill and want to avoid a repeat of of their Obamacare failures in 2017.
But she says that is not an option and voters will demand results.
"If Republicans don't act, they are going to be on the defensive," said Turner. "I believe the voters are going to insist they take action this year."
She says Republicans have about six months to get these reforms through Congress and onto Trump's desk, otherwise the improvements will not appear in premium forecasts just weeks before Election Day.