It’s been two years since Republicans fell one vote short of repealing and replacing Obamacare. Since then, Democrats have moved further to the left and pushed for a single-payer system, while Republicans have developed free-market alternatives. In today’s special edition of The Daily Signal Podcast, Rep. Mike Johnson, R-La., shares about a new plan put forward by the Republican Study Committee, which he says would lower costs and expand options for Americans. His interview begins at 8:15.
This episode was recorded at President’s Club, an annual gathering of Heritage Foundation supporters in Washington, D.C.
Rachel del Guidice: We’re honored today to be joined on The Daily Signal podcast by Congressman Mike Johnson of Louisiana, who is also chairman of the Republican Study Committee.
Congressman Johnson, thank you so much for being with us today.
Rep. Mike Johnson: Thanks for having me. It’s good to be with you.
del Guidice: Well, you are very busy right now. You’re currently in the midst of rolling out the RSC’s health care plan, which is entitled “A Framework for Personalized, Affordable Care.” Can you tell us a little bit about it?
Johnson: Yeah. Thanks so much for the opportunity. We have been working on this product that we released this week for almost a year.
Everyone remembers what happened back in 2017, the big effort Republicans made to repeal and replace Obamacare. It failed by one vote in the Senate; John McCain famously did the thumbs down, and since that occurred, there hasn’t really been any idea or proposal in this space at all. It’s been almost a vacuum of ideas.
What is filling it now is something that greatly concerns all of us, and should concern every American. That is the Democrats. All of the ones on stage running for president, and many of the leaders, [House Speaker Nancy] Pelosi and company, and the Congress, who are proposing basically two options in this crisis that we have in American health care.
Some of them want to maintain the status quo and double down on that, and the others want to move us into a government run, a one-size-fit-all health care system for America. We think that would be a disaster for the American people.
In the Republican Study Committee, which is the largest caucus of conservatives in Congress, we have 147 members. We have been working on this since January of this year to come up with sound proposals that follow with our orthodox conservative beliefs and principles, free market principles, that we believe we can insert into this space to fix what ails the American health care system.
The idea, ultimately, is to present a framework for more personalized, affordable care. We think we can drive down the cost [and] increase the quality and accessibility of health care by instituting some really simple principles that we think we’ll have a great shot of getting passed.
del Guidice: That was actually my follow-up question. You had mentioned how Democrats are really proposing two options, either the status quo or a completely government-run health care system. Why should Americans be watching, caring? …
[For] a lot of us, our own health care prices are going up, so you mentioned earlier at an event today that I was at that this is the issue of the day, and why should we be watching?
Johnson: Well, first of all, this is an issue that affects every single American, every family in this country, individuals. People are struggling with their health care.
I’m from the state of Louisiana. When I go home and do town halls with my constituents in Northwest Louisiana, I do a presentation, I give them an update on what’s happening in Washington, D.C., and then I open for questions. Inevitably, the first or second question in every town hall, no matter where I am, is about health care, the cost of health care.
That is what people are so deeply concerned about, because for a lot of Americans now, they’re paying more for health care—even in healthy families—than they are on their mortgages, and the projection of the cost is just ominous. If you look at projections of where this goes over the next three years, five years, 10 years, it’s not a sustainable model.
We can’t afford our health care, and meanwhile, the quality of care in so many places is going down, and the access to the care is going down. All this is a result of the ACA [Affordable Care Act], Obamacare, and in the way that it has failed the people and not fulfilled its promises.
So the reason that people should be paying attention—I don’t think we need to encourage them to pay attention to the issue because I think it’s top of mind for almost everyone. But if it’s not for someone, if they’re not struggling, if they’re delighted with their current health care, they need to be very afraid of what the Democrats are proposing right now.
Even amongst the candidates for president on the Democrat side, they’re having an open and public debate about it themselves.
It was just this week that [former Vice President] Joe Biden challenged [Sen.] Elizabeth Warren, for example. Oh yeah, single payer. Great. What’s that going to cost us? And he’s floating the figure $32.6 trillion over the first 10 years.
This is not a system that would work, and even some of the Democrats are willing to acknowledge that, but their proposal is to double down on what we have. That’s not going to work either. So we have to have better solutions, and we think that what we’re proposing will take us a long way in fixing this problem.
del Guidice: In the rollout to this plan, you mentioned that your plan increases access and the quality of care, rather than reducing it. Can you give us some specific ways, maybe some of your favorite examples of how it does that?
Johnson: Yeah. There’s a lot of features in this 65-page-plus report that we’ve published this week, and it’s going to be readily available for everybody to go through and read for themselves, but some of the highlights are, first, we have to take care of those with preexisting conditions.
That is a driving force for us, it’s an important mandate that we have, and we believe it’s so critical because we don’t want anybody to be left behind, but how do you do that by following with free market principles? It is possible, but it’s a different approach than what the ACA/Obamacare has done.
What we want to do, just some specific examples, just real quick, is expand HIPAA, the Health Insurance Portability and [Accountability] Act … expand that to the individual market.
HIPAA’s been part of the law since the mid-90s, and it has ensured that in the employer-based market, your health insurance follows you through your various iterations of jobs, right? But it’s an impediment to those who would want to take a risk, be a small business owner, start their own company.
To be an entrepreneur, many people don’t take that leap of faith because they’re afraid that if they lose their employer or they leave their employer, they will lose their employer-based, employer-provided health care. It doesn’t follow you if you go outside into the individual market.
So we want to fix that. We think by doing that, in a big way, we reduce the the crisis that is preexisting conditions, because if somebody gets a policy early and it follows them and they can keep it no matter what their iterations of employment, they don’t have gaps in coverage.
Your gaps in coverage [are] oftentimes when you develop a disease or an illness that makes you uninsurable later. That’s what the ACA/Obamacare was trying to fix.
So by by making HIPAA portability a big factor, we cut down on the preexisting condition concern, and you have more individual marketplace options.
We have to establish these federally-funded, state-administered guaranteed coverage pools, because that’s the way that you ensure individuals with high-cost illnesses have access to quality and affordable coverage. There’s ways to do that that are free market-based and introduce competition and help to drive the cost down. And we have some details on how that can be done.
One of the ways we do this is repackage the existing funding for the ACA premiums and the Medicaid expansion. Fund the state-administered Flex Grants, and that can be used by states as the incubators. They can innovate with this to help to subsidize that health insurance for low-income individuals. We give them the flexibility to find what works for them—and you will, you may have 50 different models for that, but that’s the beauty of our system, that they’d be able to do it. We’ll get the federal government out of the way.
And finally, one more idea is, reduce the regulatory barriers that give Americans access to quality care. We want to empower them to personalize their coverage to fit their own unique needs.
One of the biggest complaints, the biggest problems with Obamacare is you had these check-a-box systems that every policy—that you were required by the federal government originally to buy—had to have certain coverage and it didn’t work for most people.
For example, a young male triathlete doesn’t need coverage for breastfeeding equipment, right? But he had to buy a policy that had those features, and so it drove the cost up, naturally.
We want to take all that out of that, all the mandates out of that, return it to the states, and allow them to put in the qualifications to each policy that people need, and really want, and will use, and that will ultimately drive the cost down.
So without getting too deep in the weeds in a short podcast, there’s a lot of details, obviously, with all these ideas, but these are ways that we can restore the access that people have to care, the quality of the care, and ultimately drive all that cost down.
del Guidice: You mentioned that your plan really addresses some of the regulations that were in Obamacare, unnecessary coverage that people have to buy because of Obamacare. Are there some other aspects of your plan that also address some of the ills of Obamacare that won’t be part of it, if this were to become a law?
Johnson: Yeah. A lot of the regulatory infrastructure of Obamacare really worked as a disservice to the people because it drove up the cost, the compliance cost, and all the rest.
We feel like the federal government should never be involved in so many of those spaces, that it really should be left to the wisdom of the state legislatures and various places to define and determine what works best for them.
One example, with these guaranteed coverage pools, in the state of Maine, for example, three years before Obamacare, they had a good innovation in Maine and they decided they would do individual high-risk pools.
They determined that really it’s a small percentage of the population in their state that had the chronic illnesses, and cancer, and the things that were the really high-cost drivers of health care.
And they said, “What would happen if we … install a $4 surcharge on the private policy of everybody in the state, and we take those funds and we put them into a separate pool of money? We have an invisible high-risk pool, where we identify persons who have these various aliments, we put them into this other pool over here, they don’t even know it because it’s done invisibly, and we subsidize their care so that they can afford their care.”
Well, that’s a simplified explanation of the model, but it worked really well in Maine. They had more people insured, they had better access to care, they had better outcomes, higher quality, everyone was satisfied. And then Obamacare became the law of the land and it blew it all up, right?
So we want states to be able to do that kind of thing. Now, maybe not everybody will do the Maine model with … an invisible high-risk pool, but maybe they’ll do something more like a reinsurance model that some other states have done.
Whatever it is, we trust that the authority to be done at more the state and local level than it is at the federal level because the worst thing that can happen to an American is you have some nameless, faceless bureaucrat in Washington that’s getting in between the care that you would be getting from your provider, your doctor of choice.
That’s what the ACA has done to it. That’s what Obamacare has done to America. And we have to change that model so that we can return health care to the people and make it, again, more personalized and affordable.
del Guidice: In traveling back to your home state of Louisiana, you mentioned that health care is a top-of-mind issue. That’s the issue that’s brought up the most times during your town hall meetings. Are there any specific stories that you’ve taken back with you, personal stories, to D.C. where you’re remembering these people and personal stories where this is why you’re doing what you’re doing?
Johnson: Yeah, all of us have personal stories from back home and many of us have personal stories that affect our own families.
In fact, this report that we published this week is full of personal stories where people are using their names and their hometown. They’re explaining their family situation, and how under Obamacare, their situation is perilous. But we illustrate that under our principles and our plan, how their lives would be so much better.
Look in my home state of Louisiana, it’s really been a disaster. We were an expansion state under Obamacare. We did Medicaid expansion, and the resources have been wasted. I know people who … are vulnerable populations—young single mothers, people with severe disabilities, the elderly—who are in waiting lines unable to get the care that they desperately need.
Medicaid was designed to help these folks, but it can’t. Why? Because we expanded the program, we put able-bodied workers without dependence on that proverbial wagon. They’re riding along. The resources are limited, and so they get spread out further. This [is] just simple math.
What’s happened is, these people who are able-bodied and don’t need that care, many of them have high personal incomes and all the rest. It’s draining away the resources [from] the people that desperately need it.
In my state, tragically, after Medicaid expansion, our legislative auditor and others have determined that over 5,000 people have lost their lives in waiting lines, awaiting health care that they would have otherwise received if we had not expanded Medicaid in this way. It’s a tragedy, and these stories are repeated over and over and over throughout the country. We have to fix that.
We believe, as conservatives in Congress, the Republican Study Committee, we have a moral obligation to step into this arena and provide solutions that will solve that crisis and we’re really proud of what we’re presenting. We look forward to the debate that this is going to spark and we think ultimately this is going to be a great thing for the country.
del Guidice: Well, thank you for your work on this. Last question, Democrats right now, they control the House and you’re unveiling this plan at a very busy time in Congress, and even though Republicans aren’t the majority party, what is your vision for down the road, as you all debate this and potentially could vote on [it] in the future if Republicans do gain back … the majority?
Johnson: You were with us at one of these round tables we had with reporters on the Hill this week, and one of the questions was, “Gee whiz, Congressman, politically this seems like an unnecessary risk. Like, why wouldn’t you guys just wait around and see what happens?” Because we said we have a moral mandate to do this. We have a sense of urgency about this.
This is not about political timing for us. This is about solving what is, for most families, the biggest crisis that they face, and the political winds are not relevant to us in doing that.
We’re going to put these ideas out there as the only ideas that are out there. Remember, no one has presented anything in this space for going on two years. We are going to occupy that beach, so to speak, we’re going to storm the beach with these principles, these proposals, and put them out there to spark this debate. We look forward to it.
I believe that the Republican Party is going to be restored to the majority in the House in the next election cycle. I believe we’ll maintain the majority we have in the Senate. I believe President [Donald] Trump [will get] reelected, and when … all those stars align again, we’re going to be ready to roll with real ideas, real proposals on Day One to solve these problems.
It begins today. We’re not going to wait around. We’re not going to sit around. We are going to storm that beach. So, we’ve gotten out of the boat, we’re proceeding up the beach now, and by God’s grace, we’ll advance these ideas pretty far along.
del Guidice: Well, Congressman Johnson, thank you so much for being with us today.
Johnson: Thank you. Appreciate the opportunity.
