As usual, Congressman Justin Amash (R-MI) took to Facebook to explain his vote in favor of the American Health Care Act, aka RINOCare. Amash has been one of the more principles and constitutional representatives in Congress, but on this bill, it seems that he acknowledged that he was not only voting for something that was not promised to the American people, but also an unconstitutional bill.
“This is not the bill we promised the American people. For the past seven years, Republicans have run for Congress on a commitment to repeal Obamacare,” Rep. Amash wrote late on Saturday evening. “But it is increasingly clear that a bill to repeal Obamacare will not come to the floor in this Congress or in the foreseeable future.”
“When Republican leaders first unveiled the American Health Care Act, a Democratic friend and colleague joked to me that the bill wasn’t a new health care proposal; it was plagiarism,” Amash added. “He was right.”
According to Amash, the AHCA repeals less than 10 percent of the provisions of Obamacare. In his words, “It is an amendment to the ACA that deliberately maintains Obamacare’s framework. It reformulates but keeps tax credits to subsidize premiums. Instead of an individual mandate to purchase insurance, it mandates a premium surcharge of 30 percent for one year following a lapse of coverage. And the bill continues to preserve coverage for dependents up to age 26 and people with pre-existing conditions.”
That last point, Amash went on to emphasize writing, “The bill does not change the ACA’s federal requirements on guaranteed issue (prohibition on policy denial), essential health benefits (minimum coverage), or community rating (prohibition on pricing based on health status). In short, Obamacare’s pre-existing conditions provisions are retained.”
Amash also said that the latest version of the bill does allow states to seek waivers from certain insurance mandates, but they are “limited in scope” and “guaranteed issue cannot be waived.” Additionally, no one can be treated differently based on gender, and those who have continuous coverage (no lapse for more than 62 days), cannot be charged more regardless of their health status.
The Michigan congressman went on to explain the effects of that portion of the legislation.
“Consider what this means: Even in a state that waives as much as possible, a person with a pre-existing condition cannot be prevented from purchasing insurance at the same rate as a healthy person,” Amash wrote. “The only requirement is that the person with the pre-existing condition get coverage—any insurer, any plan—within 62 days of losing any prior coverage.”
“If a person chooses not to get coverage within 62 days, then that person can be charged more (or less) based on health status for up to one year, but only (1) in lieu of the 30 percent penalty (see above), (2) if the person lives in a state that has established a program to assist individuals with pre-existing conditions, and (3) if that state has sought and obtained the relevant waiver,” he continued. “Here in Michigan, our Republican governor has already stated he won’t seek such a waiver, according to reports.”
He then asked why both parties were exaggerating the effects of the bill.
For President Trump and congressional Republicans, the reason is obvious: They have long vowed to repeal (and replace) Obamacare, and their base expects them to get it done. For congressional Democrats, it’s an opportunity to scare and energize their base in anticipation of 2018. Neither side wants to present the AHCA for what it is—a more limited proposal to rework and reframe parts of the ACA, for better or for worse.
While Amash claims that the first version of the bill was “for worse,” he does state that there were “several small but important changes” that were made to the bill, specifically abandoning the “fatally flawed approach to essential health benefits (though the new approach includes new flaws), incorporates an invisible risk sharing program, and permits limited state waivers.”
However, Amash maintains that the AHCA become “only marginally better than the ACA.”
“When deciding whether to support a bill, I ask myself whether the bill improves upon existing law, not whether I would advocate for the policy or program if I were starting with a blank slate,” he wrote. “In other words, the proper analysis is not whether it makes the law good but rather whether it makes the law better. In this case, I felt comfortable advancing the bill to the Senate as a marginal improvement to the ACA. The House has voted more than 30 times to amend (not just repeal) Obamacare since I’ve been in Congress, and I have supported much of that legislation, too, on the principle of incrementalism. If it advances liberty even a little (on net), then I’m a yes.”
“Nonetheless, the ACA will continue to drive up the cost of health insurance—while bolstering the largest insurance companies—and the modifications contained in the AHCA cannot save it,” he added. “Many of the AHCA’s provisions are poorly conceived or improperly implemented. At best, it will make Obamacare less bad.”
While I do understand his thinking in trying to alleviate some measures of Obamacare to make it “better,” I don’t think that is what his oath of office calls for him to do. His oath of office calls for him to uphold the Constitution, and Amash believes this is unconstitutional. I believe Amash is rationalizing more than giving a constitutional explanation for his vote because is he had to give a constitutional explanation, there would have been nothing to write. He is admitting to keeping 90% of Obamacare in place with this bill. His job is not to make bad law better, it’s to make constitutional law.
However, I will give him credit for at least being honest enough to say what the bill is and is not, and it is not a repeal of Obamacare.
Amash was recently threatened by President Trump’s social media director who urged Trump supporters to stage a primary challenge against the legislator in 2018.
“The Framers of the Constitution understood that federalism—the division of powers between the national and state governments—would maximize the happiness of Americans. As long as Washington dictates health insurance policy to the entire country, there will be massive tension and displeasure with the system,” Amash concluded. “I’ve always said, and I will continue to say, we need to start over: Fully repeal Obamacare, let the people of each state choose their own approach, and work together in a nonpartisan manner.”