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President Obama’s Health Care Law

As I travel around Wisconsin, I hear from more and more individuals who have serious concerns about what the implementation of the ACA will mean for them, their families and their businesses. Businesses, policy experts, government actuaries, and even some supporters of the law have confirmed what the country already knew: the ACA is bad policy that does not accomplish what it was designed to do.  Instead, the law spends trillions of dollars we do not have, and raises taxes on workers, businesses and families, and puts the federal government squarely in the middle of health care decisions.

It started with cancellation notices and massive premium increases for families and individuals in Wisconsin and nationwide.  Insurance premiums remain high—in fact higher than ever before for many Americans—and they are rising faster than the rate of inflation, the economy, and average income.   These premium increases are taking a big toll on family budgets –not to mention the federal budget. Under the ACA the federal government now either directly or indirectly subsidizes most premiums, meaning the burden of rising premiums is also falling on taxpayers.  In Fiscal Year 2016, this subsidization alone will cost an astonishing $300 billion.  Unfortunately, we now know that the most damaging effects of the ACA only get worse as we look to the future.  The non-partisan Congressional Budget Office (CBO) recently projected that average employer-based premiums will go up nearly 60 percent between this year and 2025.  It should come as no surprise then that late last year, CBO also projected that, because of the ACA, the workforce will be two million full-time workers smaller in 2025 than it would be otherwise.

During the first week of the 114th Congress, the House took steps to mitigate some of the more egregious side effects of the ACA's mandates.  On January 6, 2015, the House passed H.R. 22, the Hire More Heroes Act of 2015.  This legislation would amend the Internal Revenue Code to permit an employer, when determining whether it must provide health care coverage to its employees under the ACA, to exclude employees who have coverage under a health care program administered by the Department of Defense—including TRICARE or coverage provided by the Department of Veterans Affairs.  On January 8, 2015, the House passed H.R. 30, the Save American Workers Act.  This legislation would repeal the 30-hour definition of full-time employee in the ACA for purposes of the employer mandate and replace it with a 40-hour definition for full-time employee.  Additionally, on June 18, 2015, the House passed H.R. 160, the Protect Medical Innovation Act, a bill that would repeal the excise tax that the ACA puts on medical devices like pacemakers and operating-room monitors, a tax that, in addition to killing jobs and stifling innovation, is increasing health care costs and limiting patient access to life-saving technology.  Most recently, on June 23, 2015, the House passed H.R. 1190, the Protecting Seniors Access to Medicare Act of 2015, a bill that would ensure seniors remain in control of the health care benefits they have earned by repealing the Independent Payment Advisory Board (IPAB), an unaccountable group of bureaucrats created by the ACA to ration Medicare.

As you may know, the ACA was recently challenged before the Supreme Court in a case titled King v. Burwell.  At issue in the case was Section 36B of the Internal Revenue Code, which Congress enacted as part of the ACA to subsidize health insurance purchased by individuals on exchanges established by the States under Section 1311 of the ACA through tax credits provided by the Internal Revenue Service (IRS).  Despite what some policymakers may have intended or claim to have intended, a plain reading of Section 36B seems to make clear that the ACA only permits the IRS to subsidize insurance purchased on an exchange, "established by the State under section 1311" and not on a federal exchange established under Section 1321 of the law.  Section 1321 is a provision of the ACA authorizing the establishment of federal exchanges in States that do not establish exchanges.  Although the text of the law authorizes the IRS to provide subsidies exclusively to purchases made on insurance exchanges established under Section 1311 of the ACA, the administration has unilaterally extended subsidization to include purchases on exchanges established under Section 1321, for which the law's text provides no authorization.  Despite the text of the law and the administration's stark departure from the text's plain meaning, the Supreme Court ruled in a 6-3 decision that the administration's decision to subsidize purchases other than those authorized by the text of law, does not violate the law.

Despite my disappointment with what I believe to be a deeply misguided decision in this case, I continue to believe that the ACA is unworkable, and I am more focused than ever to work to repeal the law in its entirety and replace it with a patient-centered system that expands access to health care, lowers health care costs, and puts health care decisions in the hands of patients, not bureaucrats.

As you may also know, in an effort to protect the American people from the ACA and clear the way for common sense reforms, the House has acted boldly to make use of a budget process known as reconciliation during this Congress.  After working to resolve budget differences between the House and the Senate, Representative Tom Price introduced a reconciled budget report as independent legislation on October 16, 2015.  This bill, H.R. 3762, the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015, would dismantle the president's demonstrably unworkable health care law.  Specifically, H.R. 3762 repeals the individual and employer mandates, the medical device tax, and the "Cadillac" tax on high value insurance plans.  By eliminating the most coercive and onerous pieces of the ACA and by laying the foundation for a patient-centered system, H.R. 3762 would force President Obama to deal with the fact that his health care law has resulted in higher costs and lower quality care for working families.  On October 23, 2015, in bipartisan fashion and with my support, the House passed H.R. 3762 by a vote of 240 to 189.  On December 3, 2015, the Senate passed this bill with minor changes by a vote of 52 to 47.  On January 6, 2015, the House once again acted in bipartisan fashion and passed the Senate's version of H.R. 3762 by a vote of 241 to 168.

Not surprisingly, President Obama vetoed H.R. 3762.  While the president’s refusal to admit failure and chart a better course is unfortunate, the passage of this budget reconciliation bill is a major victory for those who believe in patient-centered health care reform.  After more than five years of trying to put a bill on the president's desk to repeal his healthcare law, Congress was able to hold the president accountable for the unmitigated disaster that is his signature policy item.  Importantly, because the reconciliation process was used to achieve this victory, Congress has now shown that the ACA can be repealed without the 60 votes required to pass most legislation in the Senate.  On February 2, 2016, in bipartisan fashion, the House voted 241 to 186 to override the president’s veto.  While this bipartisan majority failed to meet the two-thirds threshold required by the Constitution to override a presidential veto, the House demonstrated its unwavering commitment to repealing the ACA by completing the entirety of the constitutional process.

As part of the effort to repeal the ACA continues, Congress must show what a better way forward would look like.  There is no doubt that health care reform is needed in this country, but the law the president signed aggravates the worst aspects of our nation’s health care system, without fixing what was and remains broken.  The troubled rollout of the ACA goes far beyond a dysfunctional website.  For too many Americans, the ACA simply means increased costs and cancellation notices.  The negative effects of this law on Americans are sweeping, and instead of offering quick fixes that only temper the consequences, Congress should instead be focused on offering much-needed reforms to our nation's health care industry.

Congress should advance solutions that strengthen health care security by taking power away from the government and insurance companies, and empowering patients with control over their care instead.  These solutions should realign incentives so that individuals and their doctors—not government bureaucrats or insurance company bureaucrats—are the nucleus of our health care system.  This requires reforms—which I have introduced in the past— to equalize the tax treatment of health care insurance, invite true choice and competition, and ensure critical programs like Medicare and Medicaid can deliver on their promises in the 21st century.  As Congressional Republicans, we must show the country our vision of patient-centered reform, and we can do so by putting forward a bold, conservative agenda in the months ahead.