It's uncanny how similar Chris Jacobs' overarching point is to the one we expressed
here in June when we said that the status quo ante Obamacare was not the way forward, and that the way forward involves getting a buy-in from moderates and liberals on reform, but not repeal, of the Medicaid expansion in exchange for repeal of Obamacare root and branch.
The difference is in solving the funding problem. Jacobs admits his plan precludes "repealing all of Obamacare’s tax increases." Our idea doesn't, in exchange for a broadly based Medicaid payroll tax to democratize the costs. 50 million participants in the small group and individual markets are bearing the burden of funding "health insurance" for the poor, i.e. Medicaid, through grossly more expensive premiums and deductibles than before Obamacare.
As others have observed, the growth of the uninsured post-Obamacare is in this group because they can't afford it anymore.
The way forward is a compromise which keeps the Medicaid expansion, funds it fairly, retains state control of the program (federalism) just as now, and repeals Obamacare.
In both the House and the Senate, debate focused on a push-pull between two competing issues: The status of Medicaid expansion in the 31 states that accepted it, and what to do about Obamacare’s regulatory regime. During the spring and summer, congressional leaders attempted messy compromises on each issue, phasing out the higher federal match for Medicaid expansion populations over time, while crafting complex processes allowing states, insurers, or both to waive some—but not all—of Obamacare’s regulatory requirements.
But rather than constructing substantively cumbersome waiver arrangements—the legislative equivalent of a camel being a horse written by committee—Occam’s Razor suggests a simpler, cleaner solution: Preserving the status quo (i.e., the enhanced federal match) on Medicaid expansion in exchange for full repeal of Obamacare’s insurance regulations at the federal level.
A “grand bargain” in this vein would give Senate moderates a clear win on Medicaid expansion, while providing conservatives their desired outcome on Obamacare’s regulations.
