Speaker of the House Paul Ryan has re-ignited the national conversation over health care policy by introducing his American Health Care Act.
Ryan himself concedes that even if his legislation passes, additional laws will be needed to do things such as allow the sale of health insurance across state lines or encourage “association health plans” that give trade groups the ability to provide health insurance to their members. Those provisions weren’t included in the American Health Care Act so that Senate Democrats won’t be able to block it with a filibuster, Ryan says.
I read the full 123-page text of the American Health Care Act. You can too at readthebill.gop. It struck me as unduly obsessed with abortion — the word appears 32 times in the bill. It also is complex.
For example, one provision reads: “FAILSAFE. — Clause (iii)(II) shall apply for only if the aggregate amount of premium tax credits under this section and cost-sharing reductions under section 1402 of the Patient Protection and Affordable Care Act for calendar year 2018 exceeds an amount equal to 0.504 percent of the gross domestic product for such calendar year.”
Any time you have Republicans making laws conditional on some pretend-precise amount such as “0.504 percent of the gross domestic product,” it’s a warning signal.
Maybe Speaker Ryan and President Trump will succeed in using the reconciliation process to ram the legislation through. Regardless, if Republicans in Washington are looking for more health-insurance reform ideas, here’s one that fits perfectly with the Trump agenda: If you’re a politically outspoken left-of-center billionaire, you’d better provide health insurance for everyone who works for you, or else the president is going to call you out about it.
Call it the Bezos rule. Jeff Bezos is the founder of Amazon.com and the owner of the Washington Post, an ardently anti-Trump newspaper. The Post editorial about the American Health Care Act was headlined “An ObamaCare repeal that’s both heartless and reckless.” Yet the Post newspaper that contained the editorial was delivered, as virtually all newspapers are, by an independent contractor who doesn’t get Washington Post-provided health insurance.
Bezos, whose net worth according to the Bloomberg Billionaires index is approximately $73 billion, has Amazon.com packages delivered much the same way — relying in part on “Amazon Flex” workers who are classified as independent contractors and therefore don’t get employer-provided health benefits. Bezos is also reportedly an investor in Uber, whose more than 100,000 drivers are also “independent contractors” responsible for their own health insurance.
Nor is Bezos the only billionaire to whom the Bezos rule might apply. Berkshire Hathaway CEO Warren Buffett, a big backer of Hillary Clinton, is richer than Bezos. Does every one of the 27,800 real estate agents who work for Berkshire Hathaway HomeServices have employer-provided health insurance?
If we were starting from scratch, it would probably make sense to divorce health insurance from employment altogether. Our current system is a relic of World War-II-era wage controls. But so long as the left is complaining that repealing ObamaCare is “heartless” — out of concern that some people may lose coverage — the least that these businessmen can do is to address the problem of lack of coverage by starting at their own companies.
Long term, solving this through a generally applicable law would be better than bullying individual businessmen. So far, though, when it comes to keeping jobs here rather than overseas, Trump hasn’t hesitated to single out individual firms. If that’s the route the president is going to take, extending the same approach to health insurance would only be consistent.
Ira Stoll is editor of FutureOfCapitalism.com and author of “JFK: Conservative.” His column appears Sunday.