EDITORIAL: Obamacare waivers could unlock laboratories of innovation
No one is guaranteed a tomorrow, but expectations run pretty high for happy days in the here and now. Americans consider first-rate health care a right tucked somewhere in the Constitution, between baseball and free hot dogs. The lengthy struggle over the proper role of government in facilitating access to modern medicine — including the grinding Obamacare tug-of-war — has reached an exhausting stalemate. With voters soon to pass judgment on the well-being of the nation, legislators at every level would be advised to get on with devising a health care system that Americans can live with. The key could be loosening the bureaucratic rules and enabling states to do what they were meant to do.
Justice Louis Brandeis framed the unique role of the states best: A “state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country.” The misnamed Patient Protection and Affordable Care Act has ignored those words of wisdom, discouraging states from devising their own best health insurance practices. Eight years on, the glaring shortcomings of cramming populations near and far into a one-size-fits-all program have become painfully clear.
Fortunately, some states are taking a frequently overlooked Obamacare exit ramp in the form of waivers that allow them to carve out something better. A recent white paper published by the Heritage Foundation titled “State Innovation: The Key to Affordable Health Care Coverage Choices” proposes a risk mitigation process through which states may collect federal money that otherwise would be paid to insurers as premium subsidies, add some of their own money and use the full sum to pay claims to policyholders with large medical bills. The effect is to avoid saddling healthy and sick members alike with ever higher premiums, and encourage more consumers to sign up for coverage.
Alaska implemented a waiver this year and reports promising outcomes. Based on interim results gathered by the Centers for Medicare and Medicaid Services, state actuaries plan to pool $64 million in federal and state and local money for risk mitigation in 2019, and they forecast a 20 percent decline in premiums and a 7 percent rise in enrollment. Minnesota and Oregon have implemented waivers with similar encouraging results. Maryland, Maine, New Jersey and Wisconsin have been approved for risk mitigation starting next year.
It’s not a moment too soon for a lesson in government inability to heal every ill. Just as every child learns to his disappointment that Santa Claus exists only in his imagination somewhere beyond the North Pole, their parents have watched with dismay that Barack Obama’s signature law cannot provide affordable health care and a lollipop. Voters are understandably anxious over the absence of a medical system miracle, and a recent Fox News poll ranks health care alongside the economy as their No. 1 concern.
The Pew Research Center found in an Oct. 3 survey that 60 percent of respondents cling to the notion that it’s the federal government’s duty to ensure that all Americans have health care coverage (with lollipop). Of those surveyed, 31 percent yearn for a system where the federal government is the “single payer” who alone decides who gets the cure and who gets the shaft.
Despite Obamacare’s broken promises of freedom to keep one’s doctor and less onerous premiums, a majority persists in backing a government-run medical entitlement in “the land of the free and the home of the brave.” It would be surprising, except for the fact that the forceful vortex swirling off the Democratic Party’s left wing is gathering strength and followers. In 2016, 51 percent of voters threw their support behind socialized medicine; now the figure is 60 percent, and only 37 percent disagree.
Turning to the federal Leviathan for health care aid may be understandable, but the outcome is unaffordable. The average premiums Americans without employer-based coverage were forced to pay under Obamacare climbed 105 percent between 2013 and 2017, according to the Department of Health and Human Services, including a 37 percent increase this year. Medical bills are expected to increase only 3 percent next year. The individual mandate repeal will enable individual taxpayers to withdraw from Obamacare next year, but without new choices, policies might still be too dear for average Americans short of a GoFundMe page.
If more states win permission to innovate, Americans may conclude that neither Obamacare nor socialized medicine is the remedy they crave. Effective solutions could be much closer at hand than in Washington.
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