Should the U.S. Supreme Court determine that the Patient Protection and Affordable Care Act of 2010 is unconstitutional, in total or in part, then Congress and the president have to go back to the drawing board. After the millions of dollars and millions of man hours spent designing and developing and beginning to implement what has come to be known as "Obamacare," it is going to be something of a challenge to come up with a replacement.
Polls have consistently shown that a majority of Americans are opposed to Obamacare, and by significant numbers. This was true before the law was enacted, and it has been true since President Barack Obama affixed his signature to it. Repeal, to coin a phrase, is easy; replacement will be hard. Especially given the impact the program is going to have on state budgets.
According to a recent if overdue U.S. Department of Health and Human Services report on the fiscal status of the Medicaid program, whose expansion under Obamacare is one of the issues being litigated this week before the nation's highest court, the new law drives up the costs of Medicaid by $169 billion through 2020 alone while adding 25.9 million people to a program that was originally intended as a safety net to insure the nation's poor had access to healthcare.
Medicaid expansion brings total burden on state budgets to $2.3 trillion through 2020, crowding out other local priorities such as education and law enforcement. Total state spending on Medicaid through 2020 is expected to total $2.3 trillion.
There's more, but the trend is clear. Under Obamacare, more people end up on Medicaid, making it more expensive and putting even more pressure on state budgets as well as the federal one. This has not gone unnoticed by the nation's governors, some of whom have come up with a set of principles for "real health reform" that goes in the opposition direction of the president.
Writing on behalf of the Republican Governors Association, Virginia Gov. Bob McDonnell—who is on the informal short list of potential vice presidential prospects for former Massachusetts Gov. Mitt Romney—outlined seven principles for reform in an op-ed published last week in Politico.
1. Health care reform should emphasize health: Health and well-being are determined by more than health services used. Employment, education and personal choices influence the health of each American. Unfortunately, the health care law undermines employment and limits personal choice. Meaningful reform should emphasize health by expanding economic opportunity and aligning incentives for Americans to make healthier personal choices that can drive improvements throughout the health care system.
2. Responsibility is best fostered through individual incentives and not an oppressive federal mandate that violates the economic freedoms of Americans: Americans should be in control of their health and the decisions regarding their care. Individuals and families, not governments, are best able to decide the right course of action, which is why price and quality transparency are essential to meaningful reform.
3. Health care reform should enable Medicaid to restore and maintain the economic independence as well as health status of the neediest Americans: Medicaid should be a bridge, not a barrier, to independence. Public assistance programs should be designed to offer support for disabled Americans and help individuals return to or maintain economic independence as well as health status.
4. Health care reform should increase design flexibility in Medicaid and the private insurance market to improve coverage choices: Increasing design flexibility in Medicaid and the private insurance market will strengthen access to care for patients, reduce the regulatory burden that increases the cost of care and lead to innovative programs.
5. Health care reform should align delivery system incentives to improve the value of patient care: Delivery incentives should be aligned to focus on quality, value-based and patient-centered programs that improve health—driving value over volume and quality over quantity while containing costs.
6. Health care reform should foster state innovation to improve health care systems: States are best able to make decisions about the design of their health care systems based on the needs, culture and values of their citizens. Reform should reduce the federal disruption in state and local health care markets while increasing accountability.
7. Health care reform should address unsustainable spending at the family, state and federal levels to ease the debt burden that threatens our future: Families, states and the federal government face a dangerous budgetary outlook made worse by this health care law. The budget problem is spending; correcting it means empowering individuals and fixing the Tax Code to remove hidden costs from the health care system.
"These principles are not partisan," McDonnell wrote, "Nor should they be considered controversial. They are, however, essential. Too often, Washington policymakers lose sight of what their goals should be by focusing on process and the political implications of their decision making."
- Rick Newman: What Would Happen if Obama's Healthcare Law Were Repealed
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