Glenn: All right. Let's go to Philip Klein. He's the managing editor of the Washington Examiner
Philip, thank you for your hard work on this. It's my understanding that this is worse than we thought it would be.
PHILIP: Yes. It is. And I think if we take a step back from the details, which we can certainly get into, as much as you think your listeners want to hear, but basically the bottom line is that this bill says and declares that liberalism has won.
And the reason -- the big question during this repeal and replace process was at the end of the day, when the dust clears, would we end up with a system that's something resembling a free market system, relative to the system that existed before Obamacare? And if we do not, then it means that liberals, through Obamacare, moved the ball forward and put us irreversibly on the course to a European-style single-payer system.
And this bill clearly is not a free market plan. You could argue -- and Republicans certainly will -- that relative to Obamacare, it taxes less, spends less, and regulates less. However, relative to any conception of what a free market for health care is, this would not be it. It still essentially has the federal government try to use a -- make sure regulations and mandates, social engineering, and massive government subsidies to try to expand the number of people covered and dictate the type of coverage that people have.
GLENN: Okay. A couple things. Cadillac tax, is that still there?
PHILIP: Basically they delayed the implementation of the Cadillac tax.
GLENN: But it's still there?
PHILIP: It's still there, but they've got rid of another plan to cap the exclusion. Because basically, keep in mind too, that the -- earlier versions of Republican and conservative replacement plans, going back a decade, did want to move away from the employer-based insurance model because if individuals have control over their own health care dollars, there are more choices, and they can take insurance with them from job to job. This is the idea of portability is something that we used to often hear about when Republicans talk about health care.
But in this case, they were afraid of disrupting the employer-based market, so they backed off from a measure that really would have tried to cap the number -- the amount and the generosity of the employer insurance deduction. But they stuck with Obamacare's Cadillac tax. They just sort of delayed it further. And a lot of this has to do with budget gimmickry for -- to work the congressional market off the score --
GLENN: Right. So, in other words, if we say we have a Cadillac tax, it looks like it can pay for itself. Or it gets a little closer to paying for itself, even though we have no intention of ever putting it in. Which really is just something that every conservative should hate because this is going to be a boondoggle.
PHILIP: Yes. Well, it's the same thing that Republicans criticized Obamacare for.
GLENN: Yeah.
PHILIP: Remember how Obamacare, what it did was it started taxing immediately. And then it delayed the heavy spending until the second half of its implementation. So there were able to say that it cost around 900 billion in the first decade, when in reality, it cost close to 2 trillion. And it looks like Republicans are doing a lot of various things such as that.
For instance, there's a lot of upfront spending that they're giving tens of billions of dollars to states to try to fund various health care initiatives. And the actual state for repeal of the Medicaid expansion and the Obamacare subsidies doesn't come into place until 2020.
Now, I don't know about you, if you're confident that going into a presidential election year, Republicans are going to allow repeal to kick in, which they're afraid to enact now. But I'm kind of skeptical that it will ever happen, in 2020.
STU: Think about this. And I actually thought there was a chance that Trump would come out and oppose it based on this because they're going to put this into effect so that all the free money goes away January 1st, 2020, in the midst of a presidential election, a few weeks before Iowa, on the Democratic side.
So that just seems completely ridiculous. There's no way these -- these guys, with all the power, don't have the spine to do it now. They're not going to do it in 2020. They're going to find out a way to extend it even longer.
GLENN: No, they think they'll still be in control. I don't think they will. They think they'll still number control. Then they can look like the sugar daddy.
PHILIP: Yeah. And the amazing thing too is it would have -- there was a much simpler solution, which is that they could have just frozen new enrollment in the Obamacare's Medicaid expansion or the exchanges. So if they were worried about transitioning people and disrupting people who already have Obamacare benefits, one thing they could have done is say if as the enactment of this law you're receiving Medicaid through Obamacare's expansion, you could continue to receive those benefits. However, we're not going to allow new enrollees. And what we've seen from other -- there was an example in Arizona, for instance, in 2000, where they got ahead of their skis in expanding Medicaid and they decided they had to scale it back. So they froze new enrollment. And within a few years, two-thirds of people have left the expanded Medicaid. That's because people find jobs. They move in and out of the health insurance market. Not everyone stays static the whole time. So if they would have been able to just even freeze it, then you would have seen dramatic wind down in the number of people that are attached -- dependent on Obamacare.
GLENN: Philip, when you say that liberalism has already won. I really don't like the word liberalism because I feel like I'm a classic liberal. And I know that has been changed, all the way from FDR. But this is really progressivism has won. The progressives in the Republican Party are just as excited as big government, fill in the blank, as any progressive on the left. They just want to be in charge of it.
PHILIP: I mean, I guess the liberal progressive thing could be argued both ways.
GLENN: Yeah.
PHILIP: Because there's also an argument that liberalism became a dirty word. So now they just want to use the word progressive because it hasn't been sort of -- it hasn't been as tainted in the public mind yet.
GLENN: Right. Well, that's because -- that's because FDR had to stop using the word progressive because they had made progressive a dirty word. So he made them liberals.
STU: Yeah.
GLENN: Yeah, it's the same thing.
Is there anything -- I've heard Trump talk about buying --
PAT: Across state lines.
GLENN: -- insurance across state lines. Is there anything like that in it?
PHILIP: I don't see that.
PAT: Wow.
PHILIP: But I don't see that from the initial bill. That might have been -- again, it doesn't mean that it won't end up somewhere. I think the buying across state lines though is kind of a limited type of thing because even in Trump's campaign, if you looked at the details, it said, "As long as you meet your state's requirements," which the whole argument for allowing interstate purchase of insurance was that there were a lot of states before Obamacare that were passing all sorts of mandates to drive up premiums. You had situations in which premiums in New Jersey or New York were double of what they were in neighboring Pennsylvania, just based on all of the regs that they were putting on it.
And so the whole interstate purchase of insurance was to try to get around that. But if you're saying policies have to meet the standards within the state, then it kind of negates that. And I also thinks there's a federalism argument in favor of not doing that and letting states formulate their insurance -- their own insurance gains. If Massachusetts wants to have a health care program in -- that more resembles Obamacare and they're willing to pay for it, then should they be allowed? And isn't it up to their citizens if they're frustrated that premiums are half the price in New Hampshire?
GLENN: Yes. Yes. Right.
STU: Philip, we kind of did this in reverse. But can you do a quick outline of what in Obamacare is staying in this bill? Because there's a substantial amount.
GLENN: We have about a minute.
PHILIP: Okay. Basically a lot of the regulations and requirements on insurance. So, for instance, the insurance -- the preexisting condition requirement.
They got rid of the mandate, but they say that, if you go without insurance for a year -- or, for more than two months over the course of a year, you have to pay a 30 percent penalty on your premiums.
GLENN: So the mandate is still there, just a different way?
PHILIP: Yeah. So then there is also -- there's -- they get rid of Obamacare's style of tax credits, but they have a new version of tax credits. So it's another form of subsidization of health insurance. And then the Medicaid expansion, they do -- it seems as though there's still going to be higher funding, relative to what would have been the place before Obamacare. However, it does move toward more of a block grant type of system.
There's some expansion of health savings accounts. But the overall scheme in terms of the requirements on insurance coverage, there's a lot more of that. It still limits the amount that people -- that insurers could charge younger -- older people, relative to younger people. Although, it would expand that to five times as much, instead of three times as much.
So basically in -- in all of the -- it basically, in many ways has less regulation, but still regulation. Lower taxes, but still includes taxes.
GLENN: All right.
STU: Obamacare-lite.
PHILIP: Lower spending, but still has the spending.
GLENN: So we put some bondo on this car and gave it a new paint job, and it's now Trumpcare.
Philip, thank you very much. I appreciate it. Philip Klein.
PHILIP: Thank you.
GLENN: He is the managing editor of the Washington Examiner.
STU: Also, the book Overcoming Obamacare. Three approaches to reversing the government takeover of health care. If you want to read what a good solution would be like, that's a good place to start.
PAT: That's a long title.
GLENN: Well, it's going to remain fiction.
STU: It will be down in the fiction section.
(laughter)
