Block grants to states with fewer strings attached to cover health care subsidies is a pragmatic and practical short-term solution in lieu of entirely ripping up and repealing the Affordable Care Act (ACA) entirely, one policy analyst has proposed.
Allowing states to have freedom to frame their own health care policies can be immediately done as the ability is already embedded in Obamacare, said Paul Howard, a senior fellow and director of health care policy at the Manhattan Institute.
“This is a pragmatic solution that can be worked on immediately,” Howard told Patient Daily. “It is something already in place and will allow the [President-elect Donald] Trump administration to hit the ground running from Day One.”
Howard proposes using the state innovation waiver, a provision largely authored by Sen. Ron Wyden (D-OR), to give the states more control over how health care is delivered.
“What we learned from Obamacare is you cannot shove something down people’s throat,” Howard said, adding there is no national agreement on a single health care solution for all 50 states.
Amendments and changes can be made later, including following in the path of President Barack Obama's administration which, Howard argued, took advantage of the “enormous flexibility” contained with the ACA.
“I think that what I would say is there is a mechanism within the ACA for states to accept a block grant of funding for exchange subsidies and premium subsidies and then to waive most but not all of the onerous regulations under the act,” Howard said. He believes this approach may receive support from Democrats.
On fears that large numbers of people may lose coverage in blue states, Howard said, “Democrats only trust Democrat states.”
“The reverse would be true,” he said. “Governors and state legislators do not want to see people dying on the streets. It would increase incentives to get it right.”
He cited energy policy that varies by state; while some have supported fracking, others such as New York have completely banned the practice.
“Nobody can say that was any kind of a disaster,” Howard said.
While Howard advocates a more nuanced but practical approach to reforming Obamacare, Trump has vowed to repeal and replace the law as soon as possible -- perhaps in the same afternoon, he said at a recent news conference.
The Senate made its first move last week, voting 51 to 48 in favor of a budget resolution that will allow it to more easily chip away as some of its provisions. The House followed suit in a 227-198 vote. But no clear proposals have been published yet as to which of the provisions will be repealed, or what will replace them.
"This resolution will set the stage for true legislative relief from Obamacare that Americans have long demanded while ensuring a stable transition," Senate Budget Chairman Mike Enzi (R-WY) said following the 1 a.m vote. "The Obamacare bridge is collapsing and we're sending in a rescue team.”
Sen. Rand Paul (R-KY) was the only Republican to vote against the budget resolution as he argues for no repeal until a replacement proposal is finalized.