Small: Oklahoma needs regulatory reform

Oklahoma needs regulatory reform

By Jonathan Small

A major focus of this year’s legislative session centers on reducing excessive government regulation.

House Bill 2728, by state Rep. Gerrid Kendrix and state Sen. Micheal Bergstrom, would create the Regulations from the Executive in Need of Scrutiny (REINS) Act of 2025.

Under the bill, any state agency rule with an economic impact of $1 million or more over a five-year period would face extra scrutiny and oversight from the Legislature.

Yet some question why Oklahoma needs this reform. The answer is simple: Because Oklahoma state agencies are as prone to overreach as government agencies in other parts of the country.

Small: Medicaid expansion’s harms continue

Medicaid expansion’s harms continue

By Jonathan Small

A key plank of Obamacare (the federal “Affordable Care Act”) allowed states to expand Medicaid programs to include able-bodied adults and not just the medically needy.

 

When expansion was narrowly approved by a public vote in Oklahoma in 2020, everyone knew it would require the diversion of up to $300 million annually in state tax dollars. But advocates called that a bargain since federal tax dollars would cover 90 percent of costs.

Obviously, it meant little to the average citizen if they pay for expansion with taxes paid to the state or taxes paid to the federal government, but that’s the kind of argument that too often passes for logic in politics.

But now the folly of buying that argument is becoming even more apparent.

Critics have long warned the 90-10 split was likely to change. Now that federal officials are trying to bring spending under control, there’s a good chance the 90-10 split could be replaced by something closer to a 60-40 split. If that happens, the state cost of Medicaid expansion could surge by $500 million to $700 million per year.

Facing that scenario, state officials should place repeal of Medicaid expansion before voters. And in the meantime, they should enact any associated budget cuts solely within Medicaid. If Medicaid expansion caused the state shortfall, Medicaid should take the hit.

Medicaid expansion was supposed to save rural hospitals. It hasn’t.

A 2024 study from the Foundation for Government Accountability found hospitals losses from Medicaid increased 115 percent from 2013 to 2021 in states that expanded Medicaid, but just 6 percent in states that did not.

In 2024 the Chartis Center for Rural Health found 22 rural Oklahoma hospitals were vulnerable to closure. A larger percentage of Oklahoma rural hospitals were vulnerable to closure than their counterparts in several states that did not expand Medicaid (such as Texas, Wyoming, Wisconsin, Mississippi and Georgia).

Similarly, a 2023 report by the Center for Healthcare Quality and Payment Reform found that about half of Oklahoma’s rural hospitals were at risk of closing with nearly one-in-three at risk of “immediate” closure.

Those numbers are significantly worse than prior to Medicaid expansion.

Similarly, Medicaid expansion has produced no notable improvement in health outcomes.

In 2019, the America’s Health Ranking report ranked Oklahoma 47th out of the 50 states in health outcomes. Today, Oklahoma is … still ranked 47th. Outcomes in several non-expansion states are significantly better.

Put simply, Medicaid expansion could quickly break the state budget, has done nothing to benefit hospitals and has failed to improve health outcomes.

As Oklahomans face a potential budget shortfall caused by Medicaid expansion, they should assess if expansion has provided meaningful benefits. Any serious analysis will end with a simple one-word response: No.

Jonathan Small serves as president of the Oklahoma Council of Public Affairs.

Rep. Brecheen, Sen. Vance introduce 'No Obamacare for Illegal Aliens' bill

Congressman Josh Brecheen, Senator JD Vance Introduce No Obamacare for Illegal Aliens Act of 2023

Washington, D.C. (July 19th) – Today, Congressman Josh Brecheen and Senator JD Vance (R-OH) introduced the No Obamacare for Illegal Aliens Act of 2023 to protect taxpayer dollars by preventing illegal aliens from receiving taxpayer-subsidized healthcare benefits.

Small: Stitt's rapid about-face on Medicaid expansion

A rapid about-face

By Jonathan Small

In the past decade, Republican governors in several states, eager for Obamacare federal dollars but aware their constituents opposed Obamacare, adopted “modified” versions of Medicaid expansion that included very minimal work requirements or premiums.

Almost all subsequently trashed those “conservative” reforms, usually after left-wing groups threatened to sue.

The same pattern can now be seen in Oklahoma, but at a much faster pace. Reportedly at the urging of Vice President Mike Pence and Centers for Medicare and Medicaid Services Administrator Seema Verma, Gov. Kevin Stitt told lawmakers Feb. 3 that he wanted Oklahoma to expand Medicaid through a federal waiver that would allow “moderate premiums and work requirements” for the estimated 628,000 able-bodied adults added to the welfare program, similar to Pence’s expansion of Medicaid in Indiana.

But by Feb. 16, Oklahoma Watch reported that Stitt’s deputy secretary of health said the state would actually expand Medicaid on July 1 with no work requirements or cost-sharing provisions. “After that, he said, the state plans to apply for a federal waiver that would incorporate many of the ideas in Stitt’s SoonerCare 2.0 plan,” Oklahoma Watch reported.

Thus, proposed “conservative” Obamacare/Medicaid expansion was abandoned in near-record time in Oklahoma—about three weeks. Sadly, the rapid abandonment of promises made to Oklahoma voters is what too often passes for government efficiency in Oklahoma.

These events prove Oklahoma’s Medicaid-expansion effort has never been about improving health outcomes or fiscal prudence. Instead, state politicians and special-interest groups cared only about getting federal money.

In the weeks ahead, we will witness lawmakers tap dance around another major Obamacare issue: Embracing Medicaid expansion means Oklahoma must come up with as much as $374 million annually to pay for it at a time the state already faces a shortfall of $85 million. Among the funding idea is, no surprise, a de facto tax increase: a hospital “fee.” The Democratic leader of the Senate had the candor to note that fee (which is being touted by Republicans) will drive up the costs of premiums for Oklahomans. Her GOP counterparts change the topic when that fact comes up.

The results of an Oklahoma embrace of Obamacare are obvious. Taxes will go up and so will health care costs. But health outcomes will remain unchanged, as can be seen by the experience of other states that expanded Medicaid like Colorado, Indiana and Arkansas. Indiana had to spike a teacher pay raise last year due to rising Medicaid costs, and citizens in those states now face higher medical bills, as even left-wing organizations concede in Colorado.

Oklahoma Republicans say they must offer an “alternative” to a Medicaid expansion plan scheduled for a public vote this year, but so far their alternative is almost a carbon copy of the ballot measure. A true alternative would involve rejecting Obamacare and focusing on real solutions, not me-tooism.

Jonathan Small serves as president of the Oklahoma Council of Public Affairs.

OCPA column: Clinging to belief in the "free lunch"

Clinging to belief in the “free lunch”

By Jonathan Small

While your parents probably warned you there’s no such thing as a free lunch, meaning a price is always paid, that’s a lesson lost on many policymakers. An obvious example is the continued argument that Oklahoma is allowing “our share” of Medicaid dollars to go to other states because we have not added able-bodied adults to the program as allowed by Obamacare.

Those who make that claim either don’t understand how Medicaid expansion is funded—through increased federal debt—or they don’t care and are willing to mislead Oklahomans. Contrary to the claims of expansion proponents, there isn’t a pot of federal money for Medicaid expansion that is simply divided by the number of states choosing to participate. Instead, Medicaid spending increases every time the program is expanded.

U.S. Sen. James Lankford, R-Oklahoma City, recently pointed out how Medicaid-expansion finances really work. If Oklahoma were to expand Medicaid, there would be a 90-10 federal-state cost split. Lankford noted Oklahoma expansion would require a “pretty significant increase” in federal spending, but the federal side would be funded via debt while state government would have to make real financial choices.

“The federal government has the great benefit of we just print more money,” Lankford said. “We don’t have to worry about having it balance. Oklahoma’s government has to figure out how they’re going to tax more, what they’re going to do less of, because they’ve got to balance at the end of it.”

As originally passed in 2010, the Affordable Care Act included numerous tax provisions that paid for the law–on paper. But many of those taxes have never taken effect, have since been repealed, or both. To cite just one example, the Democratic-controlled U.S. House of Representatives voted in July to repeal the ACA’s “Cadillac tax,” which has not taken effect but will eventually impose financial penalties on those whose insurance plans are considered too lavish, including plans serving many states’ teachers.

Put simply, Obamacare was never truly “paid for” and today is substantially funded by increasing debt.

The U.S. government’s public debt is more than $22 trillion and on pace to hit $28.7 trillion by 2029. Medicaid expansion plays a significant role in that growth. At a recent meeting of the legislative Healthcare Working Group, Clay Farris, an official with the consulting firm Mostly Medicaid, pointed out that Medicaid’s nationwide spending totaled $7.2 trillion from 1966 to 2014, including both state and federal funding. The program is now projected to spend $5.5 trillion total from 2014 to 2022. “We’re going to have spent almost as much in eight years as we did in the first 50 years,” Farris said.

Oklahoma’s decision to (so far) decline Medicaid expansion not only reduced welfare dependency in this state, but also reduced the debt burden handed down to our children.

Jonathan Small serves as president of the Oklahoma Council of Public Affairs.

OCPA column: Ducking the real Medicaid question

Ducking the real Medicaid question

by Jonathan Small

When it comes to Medicaid expansion, there are just two choices. Oklahoma can expand the program, adding up to 628,000 able-bodied adults at a potential state-taxpayer cost of $374 million annually, or Oklahoma can reject expansion and implement real, state-level reforms that target funding to rural areas, expand price transparency and improve outcomes.

There is no serious, viable alternative that melds those two positions, as recent news from Utah makes clear.

Under the Affordable Care Act, better known as Obamacare, the federal government offers to pay up to 90 percent of the cost of adding able-bodied adults to Medicaid, a much higher rate than it pays for coverage of the aged, blind and disabled currently on the program. This was done to incentivize states to expand the welfare program.

Utah officials tried to split the baby. Under Obamacare, the higher matching rate is provided for coverage of able-bodied adults with incomes up to 138 percent of the federal poverty level. Utah tried to do a partial expansion covering only those with incomes up to the poverty level. The Trump administration declined Utah’s waiver request. Basically, if Utah wants to do a partial expansion, it can, but it will receive the lower matching rates provided through traditional Medicaid. Utah will cover about 30 percent of the costs instead of 10 percent.

Oklahoma lawmakers should take note. Under the federal law, as enforced now by both Democratic and Republican administrations, Medicaid expansion is an all-or-nothing proposition.

Yet some proponents of Medicaid expansion argue they can create an “Oklahoma plan” that expands Medicaid in a modified form. That argument no longer holds water after rejection of Utah’s plan.

The blunt truth is that when “alternative” Medicaid-expansion models have gained approval from the federal government, they still provide coverage to the same people as traditional Medicaid expansion, with the same lack of restrictions as traditional expansion, at the same or higher taxpayer costs as traditional Medicaid expansion.

Some tout Arkansas’ Medicaid expansion as a model for Oklahoma, but the main difference between the Arkansas plan and traditional Medicaid expansion is that the Arkansas plan is much more expensive. One study found the Arkansas plan’s per-patient costs were more than double the cost of traditional Medicaid.

Efforts to place Medicaid expansion on the ballot and make it a constitutional right for able-bodied adults are underway, and signatures are being gathered. Some lawmakers argue this means they must pass expansion through the Legislature. In reality, the initiative petition has taken the issue out of lawmakers’ hands. The ballot measure, if approved, will supersede anything the Legislature passes. And if the ballot measure is rejected—either because the petition fails to secure enough signatures or voters reject it at the ballot box—then it’s clear Oklahomans don’t want to expand Medicaid.

Oklahoma politicians only need to declare their position on the ballot measure. Those who pretend they’re seeking an “alternative” are simply ducking the question.

Jonathan Small serves as president of the Oklahoma Council of Public Affairs.

OCPA files legal challenge to Medicaid-expansion petition

OCPA files legal challenge to Medicaid-expansion petition

OKLAHOMA CITY (May 10, 2019)–The Oklahoma Council of Public Affairs, a free-market think tank, has filed a legal challenge to an initiative petition that would expand the state’s Medicaid welfare program, saying the proposal is unconstitutional and the petition gist is so misleading it violates state law.

“There are a lot of policy reasons to oppose Medicaid expansion,” said Jonathan Small, president of OCPA. “But this initiative petition is also unconstitutional and misleading, and those problems should be addressed by the Oklahoma Supreme Court.”

Under traditional Medicaid, states like Oklahoma receive roughly 60 cents in federal money for every 40 cents provided in state funding to give government health coverage to certain low-income and disabled individuals. But under the federal Affordable Care Act, better known as Obamacare, states can receive a 90-10 match to cover able-bodied adults with income above the current eligibility threshold. Oklahoma lawmakers have opted not to expand the program, which could cost state taxpayers up to $374 million annually.

But a recently filed initiative petition would place Medicaid expansion on the ballot, and could make it part of the Oklahoma Constitution.

OCPA and fellow plaintiffs argue the petition unconstitutionally delegates legislative authority away from Oklahoma and to the federal government because the proposal would give federal bureaucrats and Congress power to control eligibility for Oklahoma’s Medicaid program and the costs borne by Oklahoma state taxpayers to support the program.

The gist, a legally required summary provided to citizens during the signature-gathering process, also includes false information and omits legally required information.

The gist says the Medicaid expansion will be for people with incomes up to 133 percent of the federal poverty level (FPL). But under federal law, expansion must include everyone with income up to 138 percent of the FPL, and partial expansion is not allowed. That difference potentially equates to thousands of people and millions of taxpayer dollars. Similar initiative petitions in Maine and Nebraska expressly established that 138 percent of the FPL was the income limit for Medicaid expansion.

The gist also fails to explain how the proposal would delegate legislative authority away from Oklahoma and to the federal government. The Oklahoma Supreme Court has struck down other petitions for similar flaws.

“This initiative petition has fatal constitutional flaws and fails to inform citizens about the real details of this massive welfare expansion,” Small said. “These flaws are so severe, the petition should not be allowed to proceed.”

The petitioners challenging the petition effort are OCPA; Small; Doug Beall, a radiologist who currently treats patients covered by Medicaid; and Jennifer Witherby, a registered nurse.

OCPA column: Hospitals raised prices after Medicaid expansion

Hospitals raised prices after Medicaid expansion

By Kaitlyn Finley

A new study shows that a key claim made by Medicaid expansion advocates is likely false.

Part of the sales pitch for Obamacare’s Medicaid expansion, which is being pushed in Oklahoma in the legislature and with a ballot measure, is that it will reduce medical bills. The argument goes like this: when hospitals treat some people for free, they have to charge everyone else more. This is called “cost shifting.” Expanding Medicaid means hospitals will have to offer less charity care, and should be able to reduce prices.

Yet many Colorado hospitals increased prices despite receiving more reimbursement payments from taxpayers after Medicaid expansion, according to a state report.

The analysis from the Colorado Department of Health Care Policy and Financing found that hospitals’ margins per adjusted patient discharge for all payer types, including Medicare, Medicaid, and the privately insured, more than doubled from $538 to $1,359 from 2009 to 2017. The state report reveals that hospitals spent their increasingly subsidized revenues on building more hospitals, particularly in metropolitan areas, on buying out physician practices, and on further consolidating hospital systems.

The report finds that these new expansion projects were focused in areas that did not need more medical facilities. “New construction seems to correspond to the regions that do not need new facilities nor new hospitals, with new hospital construction concentrated largely in the higher income areas of Colorado, such as Longmont/Boulder.” The construction was focused on these lucrative areas and largely ignored lower-income areas.

According to the report, “Hospitals could have passed on significant savings to commercial consumers had they matched national cost benchmarks using Medicare Cost Reports[,] suggesting as much as 8.3 percent in cost savings or $7.9 billion from 2009 to 2017.”

In response to these findings, Kim Bimestefer, executive director of the Colorado Department of Health Care Policy and Financing, told Kaiser Health News, “Hospitals had a fork in the road to either use the money coming in to lower the cost-shift to employers and consumers or use the money to fuel a health care arms race. With few exceptions, they chose the latter.”

Colorado’s experience shows why throwing billions of taxpayer dollars at a broken and opaque health care system by expanding Medicaid will not serve to improve health care—or lower costs—in Oklahoma.

Kaitlyn Finley is a policy research fellow at the Oklahoma Council of Public Affairs.

OCPA column: SB605 is bad policy, no matter where you try it

Senate Bill 605 is bad policy, no matter where you try it

By Kaitlyn Finley, policy research fellow at the Oklahoma Council of Public Affairs.

Although Oklahomans have wisely rejected repeated attempts to expand Medicaid under Obamacare, new proposals keeping popping up in their place like the many-headed Hydra.

The latest expansion proposal at the Oklahoma Capitol, Senate Bill 605, claims to be a “conservative” alternative to traditional Medicaid expansion. But SB 605 is just Obamacare Medicaid expansion by another name.

SB 605 would expand medical welfare benefits to a potential 628,000 able-bodied, working-age adults in Oklahoma. The program would be designed under the authority of a federal waiver. These new welfare beneficiaries would receive Medicaid benefits through commercial plans administered by another state-run program, Insure Oklahoma. If implemented, the federal government would pick up 90 percent of costs accrued from new expansion enrollees while Oklahoma state taxpayers would pay for the remaining 10 percent of costs. Based on the number of eligible enrollees and average per-person costs, Oklahoma state taxpayers could be on the hook for $374 million annually if they implemented SB 605.

Despite real-world fiscal nightmares in other states, some expansion proponents still claim that expanding Medicaid through a waiver and utilizing private commercial health plans will be a cheaper way to expand Medicaid. These are unfounded claims. Look no further than Arkansas, Iowa, and New Hampshire. These states implemented a plan similar to the one proposed in SB 605 and it left them in a financial mess.

Arkansas’ “private option” expansion plan has accrued more than $1.4 billion in cost overruns in the past three years. Iowa and New Hampshire decided to scrap their alternative expansion plans altogether in 2015 and 2018, respectively. To make matters worse, these states’ “conservative” expansion plans turned out to be even more expensive than if they had just adopted traditional Medicaid expansion in the first place.

Oklahoma lawmakers should be wary of any “conservative” option, like SB 605, to expand Medicaid through a federal waiver. Putting aside the price tag, any supposedly conservative features may be rescinded by the next liberal president, leaving Oklahoma paying the tab for all the costs from a new entitlement class of hundreds of thousands of able-bodied, working-age adults.

Oklahoma has already seen this happen when the Obama administration threatened to gut Insure Oklahoma and push individuals onto the expensive Obamacare exchange. The Obama administration did not want to approve an extension for Insure Oklahoma because the program has enrollment caps in place and generally requires beneficiaries to be working in order to receive partially subsidized health insurance. Oklahoma’s recent history with the Obama administration shows how foolish it would be to rely on temporary waivers, where authority lies solely with the federal government, particularly for proposals that have shown to be an inefficient use of taxpayer dollars.

With all the financial nightmares and program chaos surrounding waivers for Medicaid expansion and the rapid rise in Medicaid enrollment in general, states like Oklahoma should be wary of any expansion proposal. This is especially true when the whole plan relies on a temporary waiver and on promises of reimbursements from a benefactor that is already $22 trillion dollars in debt.


Kaitlyn Finley serves as a policy research fellow focusing on health care and welfare policy for the Oklahoma Council of Public Affairs.

1889 Institute argues against Medicaid expansion

INSTITUTE ARGUES AGAINST MEDICAID EXPANSION

Less affordable than it seems

OKLAHOMA CITY, OK (March 18, 2019) – The 1889 Institute has published “Obamacare Medicaid Expansion: Still a Bad Idea,” which points out the drawbacks of Oklahoma expanding Medicaid under the federal Affordable Care Act (Obamacare).

In analyzing the possibility of expanding Medicaid in Oklahoma, regardless of how it is done, three broad issues emerge. First, advocates exaggerate need but minimize fiscal risks. Second, Obamacare Medicaid expansion would only exacerbate the health care price spiral above general inflation. And third, while expansion would enrich the already-rich health industry, Oklahoma would be prevented from efficiently and effectively solving its own problems.

“What has always galled me about Obamacare is it was sold as a solution to high health care prices, but it doubled down on the very policies that caused the high prices in the first place,” said the paper’s author, Dr. Byron Schlomach, economist and Director of the 1889 Institute. Dr. Schlomach blames the poor incentives that arise when consumers rely on “third-party payers” to pay for services – Medicaid, Medicare, and health insurance – for causing high health care prices.

The 1889 Institute’s publication refutes three main arguments of advocates for Medicaid expansion. First, it disputes that more federal money will have a significant economic impact or that Oklahomans are truly paying taxes for other states’ expansions. Second, it disputes whether most hospitals need additional funds while acknowledging that there might be a need to help specific rural hospitals. And third, it disputes alleged benefits from expanded health coverage.

Dr. Schlomach argues that Obamacare Medicaid expansion would make Oklahomans more dependent than citizens of other states and that expansion risks larger cuts in education and other programs when the state suffers revenue shortfalls. “Demand for Medicaid rises when finances are tightest, and our low cost of living causes people with good standards of living to qualify for assistance in higher numbers than in other states, since the federal poverty level is not adjusted for cost of living,” he said.

Finally, the publication asks several tough questions, including: Already consuming 1/7th of the economy, how much greater of a share does health care need? And, if all hospitals need financial help, why are so many constructing new facilities and expanding right now?


About the 1889 Institute
The 1889 Institute is an Oklahoma think tank committed to independent, principled state policy fostering limited and responsible government, free enterprise and a robust civil society. The publication, “Obamacare Medicaid Expansion: Still a Bad Idea” can be found on the nonprofit’s website at http://www.1889institute.org/health-care.

Major Growth Continues in Health Care Sharing

For those of you who are long-time readers, I've written quite a bit in the past about health-care sharing and our experience as a family with this different method of dealing with health-related expenses. Back in December of 2016, I wrote an article entitled An Overview: Health Care Sharing's Tremendous Growth, detailing the surge in participation in health care sharing after the passage and implementation of ObamaCare.

Over the two months, I've gathered the latest information from the six nationally-available health care sharing ministries, but before I share the statistics let me explain what exactly "health care sharing" is, for those who are unfamiliar with the term.

Health Care Sharing - Background

Health care sharing is based on a Biblical principle found throughout the Scripture (see Acts 2:44-45), with Galatians 6:2 being a key verse: "Bear ye one another's burdens, and so fulfil the law of Christ." Applying this principle to health care means Christians banding together to share each other's medical costs.

While there are some minor differences among the major health care sharing ministries, the basic system is the same. Members usually affirm a statement of faith and agree to live a lifestyle that fits certain moral guidelines. Participants commit to a set payment each month, which is sent to fellow members who have submitted their medical bills to the ministry, which assigns those medical needs to specific members each month.

Health Care Sharing Ministries (HCSMs) "are operated by not-for-profit religious organizations acting as a clearinghouse for those who have medical expenses and those who desire to share the burden of those medical expenses." They are not insurance, but HCSMs and their members were exempted from the insurance mandate in ObamaCare and thus paid no penalty or tax during the time it was in effect. HCSMs are legal and operate in all 50 states, U.S. territories, and even have international members (such as missionaries).

HCSM members are considered cash or self-pay patients, and can generally use any physician or hospital that will accept cash/self-pay patients (some of the ministries use networks for extra savings, but they're not required). Most of the ministries also work with third-party groups to negotiate deep discounts on larger bills. Most HCSMs have limitations on pre-existing conditions, but some have more flexibility on them than others.

Health care sharing in a modern sense traces back to the Amish and Mennonites in the 1960's, but in the 1980's and 1990's several new non-denominational (generally evangelical Protestant) groups started which accepted membership nationwide regardless of church affiliation, provided they agreed to the statement of faith and guidelines (as mentioned previously).

According to the Alliance of Health Care Sharing Ministries, HHS lists 104 known and active health care sharing ministries, 97 of which are Mennonite/Old German Baptist churches or associations with closed membership. Most have fewer than 100 members.

There are currently six main, nationally-available HCSMs. Christian Healthcare Ministries began in 1981. In 1993, Christian Care Ministry started Medi-Share. Samaritan Ministries started sharing in 1994. Altrua HealthShare (2000; 1997 through merger), Solidarity HealthShare (2012; 1990s through affiliation), and Liberty HealthShare (2013; 1995 through affiliation) started sharing more recently, but are affiliated with older groups in order to qualify under the ObamaCare restrictions on HCSMs (continual existence since before 2000 is one rule).

According to a paper published by the Charlotte Lozier Institute last December, there were just over 100,000 participants in HCSMs in 2005. Growth since that time has been exponential, particularly since ObamaCare began to be implemented. I reached out to the six aforementioned ministries and obtained some statistical information to share about their recent increase in participation.

The Nationwide Ministries

We'll now examine the membership stats and brief cost explanations for each of the nationally-available HCSMs, going from largest to smallest.

Christian Care Ministry - Medi-Share

As of December 2018, there were about 411,600 individuals participating in Medi-Share; in December 2016, there were 212,400 members. There are currently about 6,800 members in Oklahoma, up from 3,170 in December 2016.

Monthly membership costs with Medi-Share are quite a bit more complicated than with the other HCSMs, more like typical health insurance. It depends on age, health, and varying initial unshareable costs ranging from $1,000 to $10,500. It looks like it ranges from a low of about $44 (single aged 18, healthy, $10,500 personally responsible before sharing) to a high of about $1,246 (head of household aged 64, 3+ member family, $1,750 pre-sharing).

Medi-Share has no per-incident or lifetime cost limits.

Christian Healthcare Ministries

Christian Healthcare Ministries was not particularly helpful in responding to my inquiry, and was especially reticent when it came to membership figures, saying "here is our policy on discussing numbers: we don’t" -- although a blog post on their site last month said they have "are serving nearly 400,000 Christians". In December 2016, they had somewhere between 150,000 and 200,000 members. They had "over 3,000 members" in Oklahoma in 2016, and would not indicate current levels, but judging from growth rates they likely have around or more than 5,000 Oklahoma members.

Monthly membership costs run from a low of $45 (one individual on 'Bronze' program) to a high of $450 (family of three or larger on the 'Gold' program). CHM's initial unshareable Personal Responsibility cost is $500 per incident for their 'Gold' level, to $5,000 per incident on 'Bronze'. All three levels share up to $125,000 per incident.

CHM also offers Brother's Keeper, an additional giving program that raises the per-incident cap to unlimited for Gold members, and adds $100,000 per year to the Silver/Bronze $125,000 per-incident cap up to a maximum of $1,000,000 (in year 10).

Samaritan Ministries International

As of December 2018, Samaritan Ministries had about 264,000 individuals participating; in November 2016, there were 209,650 members. There are currently about 4,500 members in Oklahoma, up from 3,425 in November 2016.

Monthly membership costs run from a low of $100 (single individual under age 30 on Basic, the lower membership level) to a high of $495 (family of 3+ individuals on Classic, the upper membership level). Samaritan's Classic membership level has a $300 initial unshareable cost (pre-discount) and a per-incident cap of $250,000, while their Basic membership level has a $1,500 unshareable cost (pre-discount) and has a $236,500 per-incident cap.

Samaritan also offers Save To Share, an additional giving program that raises the per-incident cap to unlimited. Members of Save To Share set aside between $133 (single individual) and $399 (3+ family) each year for use if needed by other Save To Share members.

As I've mentioned before, my wife and I have been members of Samaritan Ministries since shortly after getting married in 2012.

Liberty HealthShare and Solidarity HealthShare
(National Coalition of Health Care Sharing Ministries)

Liberty and Solidarity are affiliated organizations, with Liberty being the larger of the two. Solidarity is exclusively for practicing Catholics. The two groups comprise the "National Coalition of Health Care Sharing Ministries", which administers Solidarity and helps with their operations, utilizing Liberty's wider experience. As of December 2018, they had a combined total of 236,000 members; in November 2016, there were about 90,000 individuals participating. They have about 3,000 members in Oklahoma, up from 1,000 members in late 2016.

Monthly membership costs run from a low of $199 (single individual under age 30 on Liberty Share, their lowest level) to a high of $529 (head of household aged 30+, 3+ member family on Liberty Complete, their highest level). Their initial unshareable cost ranges from $1,00 for an individual to $2,250 for a family. Per-incident caps range from $1,000,000 on their highest level to 70% of eligible medical bills up to $125,000 on their lowest level.

Altrua HealthShare

Currently, Altrua HealthShare said they have about 20,000 individuals participating; in December 2016 there were about 25,000 members. Altrua originally began as a Mormon-oriented HCSM in 2000, but changed structure and leadership in 2005 to became non-denominational in reach. They currently have about 300 members in Oklahoma, which was the same figure I was given in 2016. Altrua seems to be the only nationwide HCSM that has not grown.

Monthly membership costs run from a low of $100 (single individual on 'Copper' program) to a high of $874 (family of 3+ members on 'Gold' program). Their initial unshareable costs are a bit complicated, but range from $500 to $7,500 on the first submitted need, and $2,500 to $5,000 on the second need.

Altrua has lifetime sharing limits of $1,000,000 to $2,000,000, with annual caps of $150,000 to $250,000 for their lowest two levels.

Growth continues significant upward trajectory

Following up from my 2016 survey of the state of Health Care Sharing Ministries, we see continued and significant growth among the nationally-available groups. They have all benefited significantly from the turmoil of ObamaCare and the individual mandate exemption available for HCSM members.

There are now over 1,300,000 individuals participating in health care sharing in these six ministries (not counting the smaller localized Amish/Mennonite groups), almost double the 712,000 in late 2016, and 13-times larger than the 100,000 members in 2008.

Here's a chart I put together with the membership information I've gathered from the previously-discussed ministries:

CCM = Medi-Share, SMI = Samaritan Min., CHM = Christian Healthcare Min., Lib/Sol = Liberty+Solidarity

The upward trend in HCSM membership began in 2010, picked up speed through 2014, and rocketed skyward from 2014 to 2016. Major growth has continued since then, albeit at a slightly lower pace. The years with asterisks are dates that I have been able to find few official figures from, and are primarily filled in by the general trends (the other years are actual statistical numbers from the ministries).

Here's the chart for the combined figures from these six nationally-available HCSMs:

There has been an increase of about 1,200% since 2008, and membership in these six HCSMs has nearly doubled in just the last two years.

Not included in these figures are members of the several dozen other organizations who have no online presence, predominately small, localized churches and ministries in the Amish and Mennonite communities. Taking these additional ministries into account, there are likely near 1,500,000 Americans participating in health care sharing organizations across the nation.

Approximately 18,000 to 20,000 Oklahomans are members of one of the six health care sharing ministries I surveyed, up from around 11,000 in 2016.

Q&A on HCSM challenges and legislation

When I reached out to the different ministries, I asked them two questions dealing with challenges facing health care sharing ministries, and legislative action that could help members of HCSMs. Here are their responses.

Q: What do you perceive to be the greatest challenges facing HCSM growth?

Samaritan Ministries:

The biggest challenge has always been the cultural mindset it takes to switch from insurance. Samaritan Ministries is not insurance and society has an insurance mindset. Making the move from insurance to Samaritan takes a shift in thinking. We take great pains to make sure inquirers understand that Samaritan is not insurance, so that also naturally dampens rapid growth. Also, growth has slowed because there are more options for Americans because of regulatory changes to short-term plans, associations plans, and the economy improved leading to more employment and employer-provided insurance.

Liberty Healthshare:

The greatest challenges facing HCSM growth are a lack of awareness of this option, and the need to build the capacity to better serve larger numbers of members. We were the first to begin using TV to market the health sharing option, and we are intensely focused on growing our capacity to process and pay bills in two months and to answer all member calls, as well as making it easier for members to interact with us and stay informed about how their costs are being shared online. We are also assessing additional options to make health sharing more holistic and customizable.

Medi-Share:

While there are bound to be changes in healthcare reform and the healthcare market will continue to evolve, our members will continue to faithfully pray for one another and share in one another’s healthcare burdens, just as they have for the past 25 years.

Christian Healthcare Ministries:

One of the biggest, if not THE, biggest enemies we have is the insurance industry and the insurance regulators thinking we are getting too big. They both are determined to shut us down because some of us have been bragging and seemingly gloating about how fast we are growing and how big we are. This is not just a problem, it is the biggest threat to our existence that currently exists.

Q: Are there specific legislative measures that you would like to see passed on the topic of Health Care Sharing Ministries? What are you doing to help push that along?

Samaritan Ministries:

In the states, we would like to have clarification in their insurance codes that health care sharing is not insurance. That clarification is already in 30 states and we look for opportunities to expand that in the future where possible. Also, tax parity on the state and federal level to allow members to deduct their shares on their income taxes. Additionally, access for members of health care sharing ministries to Health Saving Accounts (HSAs). Congressman Mike Kelly (R-PA) and Collin Peterson (D-MN) previously introduced bipartisan legislation, H.R. 2310, which would amend the IRS code to allow health care sharing members to utilize HSAs. We trust that the legislation will once again be introduced in the next session of Congress.

Liberty Healthshare:

The Trump administration is revising the rules for HRAs. We’ve advised HHS and other agencies of the federal government that inclusion of HCSMs as a viable alternative for employers offering HRAs to their employees honors the free exercise of religion, as well as accommodating religious conscience. Under the Religious Freedom Restoration Act, agencies of the federal government have broad discretion to include people of faith in their rule making. Integrating HRAs with HCSMs would accomplish an accommodation of religious practice in healthcare.

Further, some states (i.e. VT) are considering instituting their own insurance individual mandate. We have testified before state committees and advised the state agencies to include an exemption for HCSMs, following the federal model in the ACA.

Medi-Share:

We recently hired a Government Affairs & Policy Representative who is monitoring healthcare legislation and regulation at the Federal and State levels to ensure that our members’ needs are represented.

Christian Healthcare Ministries:

We are not pursuing legislative initiatives. That doesn’t mean we won’t act to protect our members to preserve their ability to exercise this freedom of religious faith or if we feel action is in their interest.

Sharing Works!

Health care sharing is a mature health insurance alternative that has been proven viable by decades of use and billions of dollars worth of medical bills shared. In this era of constant changes in health care and health insurance, it's an exciting option for Christians to consider. Tens of millions of dollars worth of medical needs are shared each and every month by one-and-a-half million individuals across the country, testifying to the fact that this really does work.

My wife and I are members of Samaritan Ministries, and it works for us. I have friends or relatives who are members of Christian Healthcare Ministries, Medi-Share, and Liberty HealthShare, and have heard positive things about each ministry. Sharing works! You might not be aware of it, but you probably know members of health care sharing ministries yourself. Regardless of the ministry, these are all good options that should be looked into.

More Information and Links

If you are interested in more information about health care sharing, or the specific ministries I've mentioned in this article, feel free to utilize these links, or contact me via email.

Nationally-available health care sharing ministries:

• Samaritan Ministries
• Christian Healthcare Ministries
• Liberty HealthShare
• Christian Care Ministry Medi-Share
• Altrua HealthShare
• Solidarity HealthShare

Alliance of Health Care Sharing Ministries: Samaritan Ministries, Medi-Share and CHM are members of this public policy organization to advocate and provide information about health care sharing to government officials and the general public.

Health Care Sharing Ministries: An Uncommon Bond, published by the Charlotte Lozier Institute, is an informative 35-page report on HCSMs and the savings experienced by members.

My personal experience with Samaritan Ministries: three different medical needs in six years, about $102,000 in medical bills were shared in full by over 110 families across the country. If you look into Samaritan and decide to join, I'd appreciate being listed as your referral (we get a credit), if you've found my information helpful. The other ministries also give referral credits, so if you decide to join a different ministry, I may know someone you could list in that ministry as well.

OCPA column: short-term health insurance brings more choice, savings

More choices, more savings: Short-term health insurance

By Kaitlyn Finley, policy research fellow at the Oklahoma Council of Public Affairs

Faced with ever-rising health insurance premiums, more Americans are searching for alternatives that won’t break their budget.

Thanks to regulatory action by the Trump administration last August, people in certain states may now take full advantage of a more affordable category of health insurance—short-term, limited-duration medical insurance (also called short-term insurance).

Unlike traditional health insurance plans, these flexible short-term plans are not subject to restrictive Obamacare regulations under federal law. As a result, short-term plans’ premiums can be up to 70 to 80 percent cheaper than certain silver and bronze plans on Obamacare Exchanges.

In addition to cost-savings, consumers may enroll in these plans any time during the year, which may help those who missed the Obamacare enrollment deadline. A recent survey of 1,000 short-term insurance beneficiaries by eHealth found that 51 percent of people would have been uninsured if they did not have access to short-term plans. Overall, recipients of these plans are generally satisfied with their coverage under these plans. eHealth’s survey found 78 percent of people who accessed medical services stated they were happy with the coverage under their short-term plan.

Under current federal regulation, these plans can offer initial coverage for up to 364 days and may be renewable for up to 36 months. In an effort to force more people to purchase Obamacare plans, the Obama administration limited their coverage to three months without the option to renew. The three-month coverage period hindered people who needed flexible health insurance coverage for interim periods, for possibly up to four to twelve months.  For instance, individuals that were still job searching or waiting for open enrollment after their initial three-month period ended were left uninsured with no options.

Although the Trump administration greatly reduced federal regulations for this category of insurance, many states still impose stronger restrictions on short-term plans. For example, state regulations in Maryland, Oregon, and Hawaii limit coverage to 90 days. As of January 1 this year, California has prohibited the sale of short-term plans entirely. Currently, Oklahoma law limits short-term plans to six months with no option to renew.

States should not ban these plans or arbitrarily suppress coverage duration. Consumers should have the ability to review all options and choose the best available insurance plan that fits their coverage needs on their schedule.

Kaitlyn Finley serves as a policy research fellow focusing on health care and welfare policy for the Oklahoma Council of Public Affairs.

OCPA column: Medicaid expansion a budget-buster

Medicaid expansion a budget-buster

by Jonathan Small, president of the Oklahoma Council of Public Affairs (OCPA)

When Oklahoma lawmakers assemble in February, they will face pressure to add hundreds of thousands of able-bodied adults to welfare.

They will be assured by many experts that expanding Medicaid under Obamacare will be cheap – in government terms – and that the federal government will foot most of the bill.

But those experts are wrong. They have been wrong every time.

Medicaid was created as a medical safety net for the most vulnerable poor – expectant mothers, children, the elderly, and the disabled. Obamacare lures states to expand Medicaid to cover childless, able-bodied adults who earn up to 138 percent of poverty income.

Since 2010, more than 30 states have taken the Medicaid expansion bait. In every case where we have numbers, the costs far exceeded predictions.

The Foundation for Government Accountability (FGA) studied the first 24 states to expand Medicaid. States expected 5.5 million new recipients; they got 11.5 million. In a report this year, FGA concluded “every state with available spending projections and actual cost data reveals that taxpayers have spent roughly 157 percent more on Obamacare expansion than state officials initially predicted.”

It’s not just state officials who got it wrong. The Centers for Medicare and Medicaid Services, the Congressional Budget Office, the Kaiser Family Foundation, the Urban Institute, and others grossly underestimated the numbers.

Even without expansion, Medicaid’s current growth rate is fiscally unsustainable. The U.S. Department of Health and Human Services estimated total Medicaid spending could reach $1 trillion per year by 2026. Right now, Medicaid is already almost a third of all state spending. Including federal reimbursement dollars, Medicaid accounted for 30 percent of the $18.2 billion spent by Oklahoma state government last year. Adding hundreds of thousands of new people would bust that budget faster and give us two dire alternatives – raise taxes or slash other services, like education or welfare benefits to even more vulnerable people.

Governor-elect Kevin Stitt opposes Medicaid expansion. But thanks to out-of-state labor unions, it may find its way to a statewide ballot in Oklahoma.

“The California union that funded successful ballot campaigns expanding Medicaid in three red states is already looking ahead to 2020,” Politico reported in November. “SEIU-United Healthcare Workers West is eyeing several states where it could bypass GOP legislatures and take Medicaid expansion proposals straight to voters – deploying millions of dollars and an army of advocates.”

The experts will again assure us that Oklahoma can absorb a vast expansion of medical welfare for the able-bodied. And just as they have been in more than 30 states so far, they’ll be dead wrong.

Jonathan Small serves as president of the Oklahoma Council of Public Affairs.

OCPA comments on federal judge ruling Obamacare unconstitional

OCPA statement on Obamacare case Texas v. United States

After a federal judge ruled Obamacare unconstitutional today, Jonathan Small, president of the Oklahoma Council of Public Affairs (OCPA), released the following statement:

“Obamacare was sold on a lie. Oklahomans and millions of Americans have lost the plan or doctor they preferred and health insurance premiums and deductibles rose significantly because of Obamacare. The law was narrowly passed and on tenuous legal gymnastics and trickery.

“A number of provisions or executive actions regarding Obamacare have been ultimately ruled unconstitutional. It's no surprise that once again the law has been found unconstitutional.”

Engle: A Cornett However...

A Cornett However...

By Richard Engle

I was at an event and got stuck talking to a musician. I am not musically inclined, so to make conversation, I asked him about the difference between a trumpet and a cornet. Knowing me he responded, “A Trump-ette is likely to be conservative, a Cornett however...”

I live in Oklahoma City and have during the entire tenure of Mick Cornett as Mayor. We have had occasion to visit before and during his terms in office. He is a nice guy. He is intelligent and he has strong communication skills. He is not a conservative by any definition.

Some will say he was a good manager of our city. Well, we have a city manager to do that. They can point to the recent MAPS projects, but should note that they are built with funds from a tax increase he supported, but the city is now faced with the costs of operation of those projects and little to nothing was done to prepare for those costs. In the waning days of his final term another tax increase was passed at his urging and those funds may well be used to plug the gap in his planning.

The most important project in the recent MAPS plan is the convention center. Any observant citizen of the city will know that it has been mired in problems and delays. He cannot be credited with a success in this matter.

His campaign seems to be taking credit for the Thunder. Nearly all of us are pleased to have a big league team, and more that they are finding success. As the team is a private business, and an expensive one, the credit should first go to the investors who bought a team in Seattle and then moved them to Oklahoma. Second, if a public entity is to be credited, the state legislature made a significant “investment” in the team. Finally, the person most directly involved in the city government’s role in getting the team here is former State Senator David Holt who has now succeeded Cornett at City Hall. Holt even wrote a popular book entitled, Big League City.

There may be little opportunity for a mayor to establish conservative credentials, but there are opportunities for the opposite. As Mayor, Mick Cornett wrote a letter to Congress to discourage any repeal of the “Affordable Care Act” also known as Obamacare. In his letter he says, “The effects of repealing the Affordable Care Act (ACA) will be most heavily felt at the local level, so it is our responsibility to protect the citizens of our cities and metro areas. The new GOP plan is bad for cities, bad for people who live in cities and bad for people who provide healthcare in cities.” He continued by stating that “healthcare is not a privilege; it is a human right.”

It should be noted that this was not a simple note to a single member of Congress. This was a formal and public letter from the U.S. Conference of Mayors and Cornett was the primary signatory and the head of the organization.

Does it need to be stated that conservatives do not favor Obamacare?

What of other issues of import to conservatives? Cornett has no record nor known stated opinions or policies that could be considered pro-life, pro-2nd Amendment, or favoring smaller government. Regarding the final matter, he is quite proud of his expansion of government in Oklahoma City. His tenure as Mayor, the longest in city history, did not include a single significant improvement in efficiency or cost reduction in city services.

The other GOP candidates have variant levels of conservative credentials. Mick Cornett not only lacks the same, he has abundant evidence of the opposite.

No one who votes for Mick Cornett will have any cause to consider themselves to be a conservative, and if the OKGOP nominates him it abolishes the moniker “conservative” from its description.

Richard Engle is a longtime conservative Republican activist, a former city councilman, and businessman.

Pledge-Breaker Mullin slams Senators for breaking pledges

2nd District Congressman Markwayne Mullin posted a video Saturday morning in which he slammed several Republican senators for breaking pledges.

He's specifically referring to Senators Collins, McCain, Murkowski, and Paul for failing to support the Graham-Cassidy healthcare plan that was the last proposal put forward by the Republican-led Senate to [sorta] repeal and [sorta] replace ObamaCare.

I agree with his outrage over Republicans failing to keep their promises, particularly on ObamaCare. However, the irony here is simply too much to ignore.

Allow me to remind Congressman Mullin to look in the mirror, where he will see a man who repeatedly pledged to the voters of the 2nd District that he would only seek three terms in the House, yet has brazenly decided to break that pledge.

Yes, I'm upset at Republicans like Mullin who fail to keep their promises. As I said in a recent post, it's another example of the death of honor in the GOP. For him to sanctimoniously criticize others for breaking promises while his very campaign is a broken promise is hypocrisy of the first-degree.

Here's Mullin's video:



Unsurprisingly, I am blocked from commenting on any of Mullin's posts, or even from liking his page.

Must read: 'GOP cave on Obamacare repeal is the biggest broken promise in political history'

This is hands down the best article I've seen on the failure of the AHCA (aka 'SwampCare', aka 'RyanCare', aka 'TrumpCare', aka 'ObamaCareLite', aka 'Renege & Repair') by Philip Klein of the Washington Examiner.

Here's part of the article - you can and should read it in full here.

GOP cave on Obamacare repeal is the biggest broken promise in political history

Broken promises are as old as politics itself, and there are many famous examples of them in modern history. President George H.W. Bush's "read my lips, no new taxes" pledge comes immediately to mind, as does President Bill Clinton reneging on his middle-class tax cut, and President Barack Obama never closing Guantanamo Bay. But in each of those cases, those were promises that were made in a given campaign by a given politician. The promise of Obamacare repeal is much different.

Republicans ran on repealing and replacing Obamacare for seven years, over the course of four election cycles. They won the House majority in 2010 in large part because of the backlash against the passage of Obamacare — and the vow to "repeal and replace" Obamacare was part of their "Pledge to America" campaign document that year. The botched rollout of Obamacare helped them win the Senate in 2014. House candidates, Senate candidates, gubernatorial candidates, and even state legislative candidates ran against Obamacare — and won.

Though President Trump was always an unorthodox candidate on healthcare (vacillating between praising single-payer and touting a free market plan), he consistently campaigned on repealing and replacing Obamacare, and exploited news of spiking premiums in the weeks leading up to the presidential election.

Republicans were always moving the goal posts on voters. That is, during campaign season, they made boasts about repeal, and then once in office, they talked about procedural complications. In 2010, they campaigned on repeal, but by 2011, they said they needed the Senate. In 2014, they won the Senate, but by 2015 they said as long as Obama was in office, nothing would become law. In 2016, they told conservative voters, even reluctant ones, that if they voted for Trump despite any reservations, they'd finally be able to repeal Obamacare. In November, voters gave them unified control of Washington. And yet after just two months on the job, they have thrown in the towel and said they're willing to abandon seven years of promises.

There are a lot of people who want to conveniently lay the blame for this stunning failure on recalcitrant members of the conservative House Freedom Caucus. If only these conservative hardliners were willing to give way, we'd be on the road to repeal, defenders of leadership would like to have us believe. This is convenient, both because there are always people in Washington eager to take aim at conservative purists, and also because it has the makings of a great ironic hot take for journalists: "How conservatives saved Obamacare."

Now, let me be clear, in past fights, I've never been reluctant to criticize hardliners when I thought that they were being unreasonable or irresponsible. For instance, I disagreed with the hard-line position on the debt ceiling, didn't think forcing a government shutdown to defund Obamacare would work, and supported the deal that made most of the Bush tax cuts permanent (as opposed to letting them all expire). But I don't think it's fair to scapegoat Freedom Caucusers here. They are being blamed for making the naive mistake of assuming that Republicans wanted to do what they were promising to do for seven years.

In this case, the hardliners were playing a productive role by pointing out the real policy consequences of the piecemeal approach being pursued by the House leadership. Though we'll never know for sure how the numbers might have looked if a vote had taken place, it's clear that many centrist members of the Republican caucus were also prepared to vote this bill down. House conservatives, if they could be blamed for anything, it's for having the audacity to urge leadership to actually honor seven years of pledges to voters to repeal Obamacare. If anybody was moving the goal posts, it wasn't Freedom Caucusers, it was those who were trying to sell a bill that kept much of Obamacare's regulatory architecture in place as a free market repeal and replace plan.

Sure, I know, Republicans had a narrow majority, and they could only pass something through the Senate by reconciliation, which imposes limitations. But the thing is, Republicans don't hide behind the vagaries of Senate procedure during campaign season. Trump did not win the Republican nomination telling rallies of thousands of people, "We're going to repeal and replace Obamacare — as long as it satisfies the Byrd rule in the judgment of the Senate parliamentarian!"

What's so utterly disgraceful, is not just that Republicans failed so miserably, but that they barely tried, raising questions about whether they ever actually wanted to repeal Obamacare in the first place.

Read the full article at the Washington Examiner (they really need to tone down the popup ads, though...).

House Freedom Caucus wins, ObamaCare "Repair" pulled

Prominent Freedom Caucus members who led the fight against the AHCA
L-R: Chairman Mark Meadows (NC), Justin Amash (MI), Thomas Massie (KY), Raul Labrador (ID), Jim Jordan (OH)

After a lot of drama and negotiations this week over the Affordable Health Care Act, U.S. House leadership pulled the bill and canceled a vote on the measure. The ObamaCare repeal replacement repair plan had taken heavy criticism from conservatives in both the House and Senate, but especially from members of the House Freedom Caucus.

Congressman Mo Brooks (R-AL) of the Freedom Caucus called it “[O]ne of the worst bills I have seen in my 30 years as a county commissioner, legislator, district attorney and now congressman,”

After seven years of promising to "repeal and replace ObamaCare", Speaker Paul Ryan and President Trump came up with a lame excuse of a healthcare plan, with no full repeal, no full replacement, and essentially just tinkering around the edges.

Earlier in the week, it looked like the bill would pass, with a lot of strong-arming from leadership and pressure from Trump and Vice President Mike Pence. Even Oklahoma's Jim Bridenstine (a Freedom Caucus member) caved and lent his support late Wednesday night - although I imagine he might regret that decision now.

However, most Freedom Caucus members held firm in their opposition, and after the vote was postponed to today, then to this afternoon, other more moderate Republicans began to bail. Now, it appears that House Republicans may be moving on from healthcare reform altogether, rather than taking up the repeal bill passed with almost unanimous Republican support just last year that President Obama then vetoed.

From Allahpundit at HotAir: "So … that’s it? An ill-conceived two-month effort in the House falls short and Republicans throw in the towel on seven years of trying to replace ObamaCare? The White House doesn’t want to offer its own alternative? McConnell has nothing in the pipeline he might want to suggest?"

After the bill was pulled, President Trump told news reporter Robert Costa "No, I don’t [regret starting his agenda with healthcare], but in a way I’m glad I got it out of the way."

After posting that quote, Allahpundit continued: "You’re glad you “got it out of the way”? Republican voters handed them the House in 2010, the Senate in 2014, and the White House in 2016, and we got exactly 63 days of meaningful effort to unseat O-Care."

Here's what Erick Erickson said at TheResurgent about this:

The House Freedom Caucus just saved the Republican Party from itself and saved the United States from a Republican attempt to just do something on health care no matter how bad that something might be.

They stood on principle and are being assailed for it by the Republican establishment.

The legislation was deeply flawed and would have hurt a great many Americans. It would have made it harder for free market solutions to lower costs in health care and would have harmed senior citizens.

Obamacare is a terrible piece of legislation and Republicans promised for seven years to repeal it. The American Health Care Act embraced Obamacare and kept it. The House Freedom Caucus stood up both to the Republican leadership in Congress and President Trump and demanded promises made be promises kept. They also exposed Republicans as having no intention of ever really repealing Obamacare.

In 2015, Republicans passed a plan through Congress that would have repealed Obamacare. All the people who voted for it are still there. It passed the House and Senate. That should have been the starting framework. But like the dog that caught the car, Republicans did not know what to do once they finally had the House, Senate, and Presidency.

Their first reaction was to abandon their small government principles and free market beliefs to prop up a government run health care scheme. The only people who stood up for the free market and the people are members of the House Freedom Caucus. They are owed our thanks.

Lastly, I should note that the only reason we have a House Freedom Caucus is because John Boehner led an establishment coup of the Republican Study Committee. The once great organization converted into an organization that rubber stamps the agenda of leadership with elaborate kabuki theater to make it seem like the outcome was in jeopardy when it never was. Sadly, the RSC’s behavior in this proves the House Freedom Caucus is still needed.

Republicans need accountability partners, not yes men. Mark Meadows, Jim Jordan, and the House Freedom Caucus are brave to shoulder the weight of accountability when others wish they would serve as yes men. They have done well today.

Like I said earlier this month, Republicans were elected to power based on the promise of full repeal. We expect nothing less than full repeal. Republican member of Congress need to keep their promise, and pass full repeal of ObamaCare.

If they don't follow through, then what is the point in electing them?

Bridenstine: I will vote “Yes” on AHCA

Statement on Obamacare Repeal

The vote on the American Healthcare Act is a very tough decision.  As the Representative of the First District of Oklahoma, my philosophy has been to fight for the most conservative option possible, and I often vote “No” to get to a “better Yes”.  Today, I decided the American Healthcare Act is the best “Yes” that the House is able to accomplish legislatively at this time.  Conservatives worked very hard to improve this bill, and while we hoped for a better bill, this is a dramatic improvement over Obamacare.

Obamacare is collapsing on itself with massive increases in premiums and deductibles so high that some families are effectively uninsured.  Many states have lost health insurance providers where companies cannot afford to offer Obamacare-compliant policies.  A third of all counties, including every county in Oklahoma, have only one provider on the exchanges this year and another third have only two.  Seven years ago, Obamacare took over nearly 20 percent of the U.S. economy, and unwinding that tangled system is extremely complex.

This bill effectively repeals the individual and employer mandates, cuts $1 trillion in taxes, and reduces the deficit by hundreds of billions of dollars over ten years.  The bill fundamentally transforms Medicaid from an open-ended and unsustainable entitlement to a State-centered system which caps the Federal contribution and maximizes flexibility for the States.  The Medicaid reforms alone will save trillions over the long-term, help move millions of people onto private insurance, and preserve the safety net for the most vulnerable.

Most important to me, this bill prohibits funds from going to the nation’s largest abortion provider, Planned Parenthood, and redirects federal funding to Community Health Centers.  This provision alone merits support even though the bill falls short of what conservatives wanted to accomplish.

I am disappointed that this legislation did not include provisions to repeal the Obamacare health insurance regulations which are the root cause of skyrocketing premiums and employers dropping coverage.  Fortunately, Tom Price, Secretary of Health and Human Services, will exercise his authority under the law to remove costly Obamacare regulations.  I also have great reservations about the bill’s refundable tax credit scheme, which is essentially a different version of the Obamacare subsidy program.

In my judgment though, this is the opening legislative salvo of the Trump Presidency, and we cannot let it fail when we do not have a shot at a better option.  Therefore, I will vote “Yes”.