To paraphrase Mark Twain, rumors of the demise of bipartisanship in health care are greatly exaggerated. While Republicans and Democrats claim different principles on health policy, their actions indicate a surprising level of agreement.
To wit: Both President Trump and President Obama took action to prevent Americans from suffering dramatic premium spikes due to Obamacare’s insurance mandates. Yet somehow the Left’s indignation over Trump’s alleged “sabotage,” in the form of his recent executive order on health care, has not extended to Obama’s actions four years ago.
In the fall of 2013, the Obama administration essentially decided not to enforce portions of Obamacare. At the time, healthcare.gov remained in full meltdown, and millions of Americans received cancellation notices stating their existing individual market coverage would end on January 1, 2014, for not complying with Obamacare’s regulatory regime. Faced with a political uproar over what PolitiFact later dubbed the “Lie of the Year”—“If you like your plan, you can keep it”—the administration issued guidance allowing states to keep plans that did not comply with Obamacare’s new benefit requirements.
It’s Cool Only If Obama Does It?
Following its initial decision to permit non-compliant plans, the Obama administration repeatedly extended these “transitional” arrangements. In March 2014, after the insurance exchanges began to function more smoothly, the Centers for Medicare and Medicaid Services extended the non-compliant plans through October 2016, followed by a further extension through October 2017. Upon taking office earlier this year, the Trump administration extended the non-compliant plans a fourth time, through December 2018.
On no fewer than three separate occasions, then, the Obama administration expressly permitted Americans to hold policies that did not comply with Obamacare’s new regulatory regime—its prohibition on pre-existing condition restrictions, its essential health benefits requirements, and its myriad other new mandated subsidies. In perpetuating these non-compliant plans, the Obama administration’s actions parallel President Trump’s recent executive order, which among other proposals would expand access to short-term insurance policies.
As with the plans that Obama thrice permitted, short-term insurance policies need not adhere to the regulations Obamacare permitted, from the pre-existing conditions requirements to age rating bands to mandatory benefits like maternity care. Short-term plans, like the non-compliant plans the Obama administration permitted, can provide a much more affordable alternative to Obamacare-compliant coverage, for which premiums have more than doubled since 2013.
Actually, Trump’s Actions Are Better than Obama’s
While creating more affordable coverage options, the Trump administration’s action expanding access to short-term insurance plans could also bring a refreshing adherence to the rule of law. In fall 2013, the Obama administration’s actions represented an extra-legal measure to permit non-compliant plans. The statute included no exemption for these plans, meaning the administration violated its constitutional duty to take care that the laws be faithfully executed, because President Obama feared the political implications of cancelling millions of health plans that he promised Americans they could keep.
Conversely, Obamacare expressly exempts coverage of less than one year in duration from its regulatory requirements, allowing for lawful action by the Trump administration in this sphere. Expanding access to short-term insurance plans of up to 364 days in length, while ending the existing non-compliant plans arrangement the Obama administration started, would create more affordable coverage options, while ceasing President Obama’s sabotage of the rule of law.
Critics claim that expanding access to short-term insurance coverage would bifurcate insurance markets, thereby “sabotaging” exchange regimes. But in some states, President Obama’s actions regarding non-compliant plans undermined the exchanges well before Trump ever took office.
For instance, in 2016 90,000 Iowa residents retained non-compliant plans—compared to only 55,000 enrolled in the Obamacare-compliant exchange coverage—and the latter endured higher premium increases than the former. Liberals attacking Trump over reports he personally intervened in Iowa’s application for a federal waiver to change its insurance markets fail to recognize that executive actions by Obama, not Trump, created the conditions where Hawkeye State officials felt the need to apply for a waiver in the first place.
Instead of attacking Trump for “sabotage,” the Left would do well to admit that Obamacare’s insurance regulations have made insurance unaffordable for many. Obama conceded as much when he repeatedly extended the “transitional” accommodation for non-compliant coverage. President Trump’s executive order would continue the bipartisan tradition of providing relief from the law’s onerous regulations, until Congress can once and for all act to end Obamacare’s “sabotage” on Americans’ wallets.
Mr. Jacobs is founder and CEO of Juniper Research Group, and a senior policy analyst for the Texas Public Policy Foundation. He is on Twitter: @chrisjacobsHC.