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January 22, 2021
Beginning Again –– Issue #114

And now we begin a new chapter in our decades-long endeavor to fight for health freedom.

We face many hurdles, but after 25 years of engaging in the health policy debate, we are ready to face these challenges and seek new opportunities to advance patient-centered reform.

The Biden administration will push an agenda that further expands the role of government in the health sector, including spending much more on Obamacare, creating a new government-run insurance plan called the “public option,” and looking to add a new class of people to Medicare despite the program careening toward insolvency.

We believe we have better ideas to expand coverage, lower the cost of health care, increase choices, and provide for the most vulnerable. Our Health Care Choices 20/20 proposal is uniquely suited to achieve those goals with dozens of specific recommendations that can be implemented at the federal or state levels. Many of our recommendations could garner bi-partisan support, and we will work, as we always try to do, with those from both sides of the aisle.

What’s ahead?  Galen Senior Fellow Doug Badger taped a podcast that I think you will find illuminating hosted by Chip Kahn, the knowledgeable and politically savvy president and CEO of the Federation of American Hospitals. Doug has decades of experience in the Senate and White House and now with both Galen and Heritage as a top leader in designing free-market policy and was paired with the equally experienced Chris Jennings, president and founder of Jennings Policy Strategies.

In addition to keen insights about the processes of making policy in the White House and action to combat Covid, key points Badger makes:
  • We are already near universal coverage. “When you look at the uninsured…most people who are uninsured right now have access to coverage—free coverage through Medicaid, free or virtually free coverage through the exchanges, and a big chunk of people who decline employer-sponsored insurance.”  Most of the others are those who are not lawfully present in the U.S. and people in states that have not expanded Medicaid, he says.  

    He has written that “The overwhelming majority of those lacking insurance could have obtained coverage but did not enroll…It’s critical that policymakers understand the distinction between lack of coverage and lack of access to coverage.”
     
  • Gubernatorial elections in Texas and Florida in 2022 are likely to be key battlegrounds over Medicaid expansion. “I’m not sure that Congress will resolve Medicaid expansion, but the two big states that haven’t expanded are Florida and Texas,” Badger said. “Both have gubernatorial elections coming up in 2022…so I expect that issue may be resolved by the states rather than the federal government.” (Here’s our latest paper explaining why expansion is not the solution.) 
Chris Jennings, who has decades of experience advising Democratic leaders on health policy, provided an overview of the Biden administration’s agenda. Among many other topics, Jennings says the new administration is demonstrating its focus on battling Covid by appointing officials on the White House staff to lead the effort.

The 35-minute podcast is definitely worth your time.

A bit of good news:  A coalition of free-market policy experts submitted on Dec. 29 a comment letter drafted by Galen Senior Fellow Brian Blase urging the Centers for Medicaid and Medicare Services to institute policies that give states flexibility to create programs better tailored to their own citizens’ needs.

In 2018, the Trump administration revised the Obama administration’s overly restrictive guidance involving Section 1332 of the Affordable Care Act. The new guidance expanded states’ ability to obtain “State Relief and Empowerment Waivers” by providing a more flexible interpretation of the statutory guardrails. This made it easier for states to improve their health insurance markets and better help those with chronic and pre-existing conditions.

In our comment letter, we had recommended that the Trump administration’s more flexible 2018 guidance be codified.  CMS agreed and in the 11th hour finalized the rule which now has been published in the Federal Register.

In the short time since the 2018 guidance was issued, many states used Section 1332 waivers to lower health insurance costs and expand coverage, as Doug Badger has chronicled.  How Health Care Premiums Are Declining in States That Seek Relief from Obamacare’s Mandates

Here is the CMS news release that says, in part: “Flexibility to help states develop their own health care programs that meet unique local needs. Implemented through 1332 waivers, this update solidifies an important opportunity for states to waive certain statutory requirements to create health programs tailored to their own citizens, subject to federal approval. The final rule codifies in regulatory text guidance published in 2018 to give states greater certainty over how the federal government will evaluate and monitor section 1332 waivers moving forward.”

The Biden administration can be expected to revisit this, but hopefully it will take them time, and because it is a final rule, it will have to consult with the states in making any changes. So this is a win.
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