Responsible Path to Full Obamacare Repeal Act

— 470 — Mandate for Leadership: The Conservative Promise from the subsidized market, giving the non-subsidized market regulatory relief from the costly ACA regulatory mandates.39 l Strengthen hospital price transparency. In 2020, CMS completed its rule to require hospitals to post the prices of common hospital procedures.40 Future updates of these rules should focus on including quality measures. Combined with the shared savings models and other consumer tools, these efforts could deliver considerable savings for consumers.41 Center for Consumer Information and Insurance Oversight (CCHO). CMS also plays an outsized role in overseeing the Obamacare exchanges, includ- ing managing Healthcare.gov, through the Center for Consumer Information and Insurance Oversight (CCIIO). While Obamacare limits plan options, CCIIO has been overly prescriptive in dictating what benefits and types of health plans may participate in the exchanges, thereby actually stifling market innovation and driv- ing up costs. Congress should build on the Trump Administration’s efforts to expand choices for small businesses and workers, both in and out of the exchanges, by codifying an expansion of association health plans, short-term health plans, and health reim- bursement arrangements (including individual coverage HRAs). CCIIO should also work with the Treasury Department and the Office of Management and Budget (OMB) to give consumers more flexibility with their health care dollars through expanded access to health savings accounts. EMERGENCY PREPAREDNESS l Expand the scope of practice of low-complexity and moderate- complexity clinical laboratories. During the COVID-19 pandemic, allowing laboratories greater regulatory flexibility regarding CLIA requirements increased access to testing. However, the need for regulatory flexibility is not limited to emergency situations. Ongoing innovations in medical care will continue to drive demand for clinical testing and new tests. One way that increasing demand for other medical services has been accommodated is by revising restrictions on scope of practice to enable providers to practice at the so-called top of their license. CMS should similarly revise CLIA rules regarding scope of practice for clinical laboratories and testing personnel.42 l Create CLIA-certification-equivalent pathways for non-clinical laboratories and researchers. The COVID-19 pandemic revealed that the U.S. needs to leverage the expertise of non-clinical laboratories and researchers in order to bolster clinical testing capacity. To accomplish this,

— 470 — Mandate for Leadership: The Conservative Promise from the subsidized market, giving the non-subsidized market regulatory relief from the costly ACA regulatory mandates.39 l Strengthen hospital price transparency. In 2020, CMS completed its rule to require hospitals to post the prices of common hospital procedures.40 Future updates of these rules should focus on including quality measures. Combined with the shared savings models and other consumer tools, these efforts could deliver considerable savings for consumers.41 Center for Consumer Information and Insurance Oversight (CCHO). CMS also plays an outsized role in overseeing the Obamacare exchanges, includ- ing managing Healthcare.gov, through the Center for Consumer Information and Insurance Oversight (CCIIO). While Obamacare limits plan options, CCIIO has been overly prescriptive in dictating what benefits and types of health plans may participate in the exchanges, thereby actually stifling market innovation and driv- ing up costs. Congress should build on the Trump Administration’s efforts to expand choices for small businesses and workers, both in and out of the exchanges, by codifying an expansion of association health plans, short-term health plans, and health reim- bursement arrangements (including individual coverage HRAs). CCIIO should also work with the Treasury Department and the Office of Management and Budget (OMB) to give consumers more flexibility with their health care dollars through expanded access to health savings accounts. EMERGENCY PREPAREDNESS l Expand the scope of practice of low-complexity and moderate- complexity clinical laboratories. During the COVID-19 pandemic, allowing laboratories greater regulatory flexibility regarding CLIA requirements increased access to testing. However, the need for regulatory flexibility is not limited to emergency situations. Ongoing innovations in medical care will continue to drive demand for clinical testing and new tests. One way that increasing demand for other medical services has been accommodated is by revising restrictions on scope of practice to enable providers to practice at the so-called top of their license. CMS should similarly revise CLIA rules regarding scope of practice for clinical laboratories and testing personnel.42 l Create CLIA-certification-equivalent pathways for non-clinical laboratories and researchers. The COVID-19 pandemic revealed that the U.S. needs to leverage the expertise of non-clinical laboratories and researchers in order to bolster clinical testing capacity. To accomplish this, — 471 — Department of Health and Human Services CMS should create pathways for granting non-clinical laboratories and their testing personnel CLIA certification equivalency. Non-clinical researchers already demonstrate their technical expertise through online training and certification programs. CMS should build on that existing framework so that those laboratories and personnel can similarly demonstrate their clinical testing capabilities.43 LIFE, CONSCIENCE, AND BODILY INTEGRITY l Prohibit abortion travel funding. Providing funding for abortions increases the number of abortions and violates the conscience and religious freedom rights of Americans who object to subsidizing the taking of life. The Hyde Amendment44 has long prohibited the use of HHS funds for elective abortions, but an August 2022 Biden executive order45 pressed the HHS Secretary to use his authority under Section 1115 demonstrations to waive certain provisions of the law in order to use taxpayer funds to achieve the Administration’s goal of helping women to travel out of state to obtain abortions. Moreover, the Department of Justice Office of Legal Counsel (DOJ OLC) issued a politicized legal opinion declaring, for the first time in the history of Hyde, that this action did not violate the Hyde Amendment and that Hyde applies only to the performance of the abortion itself in violation of the plainly broad language that Congress used. Two of the first actions of a pro-life Administration should be for HHS to withdraw the Medicaid guidance (and any Section 1115 waivers issued thereunder) and for DOJ OLC to withdraw and disavow its interpretation of the Hyde Amendment. l Prohibit Planned Parenthood from receiving Medicaid funds. During the 2020–2021 reporting period, Planned Parenthood performed more than 383,000 abortions.46 The national organization reported more than $133 million in excess revenue47 and more than $2.1 billion in net assets.48 During this same year, Planned Parenthood reports that its affiliates received more than $633 million in government funding and more than $579 million in private contributions.49 Planned Parenthood affiliates face accusations of waste, abuse and potential fraud with taxpayer dollars, failure to report the sexual abuse of minor girls, and allegations of profiting from the sale of organs from aborted babies. Policymakers should end taxpayer funding of Planned Parenthood and all other abortion providers and redirect funding to health centers that provide real health care for women. The bulk of federal funding for Planned

— 7 — Foreword Instead, party leaders negotiate one multitrillion-dollar spending bill—several thousand pages long—and then vote on it before anyone, literally, has had a chance to read it. Debate time is restricted. Amendments are prohibited. And all of this is backed up against a midnight deadline when the previous “omnibus” spending bill will run out and the federal government “shuts down.” This process is not designed to empower 330 million American citizens and their elected representatives, but rather to empower the party elites secretly nego- tiating without any public scrutiny or oversight. In the end, congressional leaders’ behavior and incentives here are no differ- ent from those of global elites insulating policy decisions—over the climate, trade, public health, you name it—from the sovereignty of national electorates. Public scrutiny and democratic accountability make life harder for policymakers—so they skirt it. It’s not dysfunction; it’s corruption. And despite its gaudy price tag, the federal budget is not even close to the worst example of this corruption. That distinction belongs to the “Administrative State,” the dismantling of which must a top priority for the next conservative President. The term Administrative State refers to the policymaking work done by the bureaucracies of all the federal government’s departments, agencies, and millions of employees. Under Article I of the Constitution, “All legislative Powers herein granted shall be vested in a Congress of the United States, which shall consist of a Senate and a House of Representatives.” That is, federal law is enacted only by elected legislators in both houses of Congress. This exclusive authority was part of the Framers’ doctrine of “separated powers.” They not only split the federal government’s legislative, executive, and judicial powers into different branches. They also gave each branch checks over the others. Under our Constitution, the legislative branch—Congress—is far and away the most powerful and, correspondingly, the most accountable to the people. In recent decades, members of the House and Senate discovered that if they give away that power to the Article II branch of government, they can also deny responsi- bility for its actions. So today in Washington, most policy is no longer set by Congress at all, but by the Administrative State. Given the choice between being powerful but vulnerable or irrelevant but famous, most Members of Congress have chosen the latter. Congress passes intentionally vague laws that delegate decision-making over a given issue to a federal agency. That agency’s bureaucrats—not just unelected but seemingly un-fireable—then leap at the chance to fill the vacuum created by Congress’s preening cowardice. The federal government is growing larger and less constitutionally accountable—even to the President—every year. l A combination of elected and unelected bureaucrats at the Environmental Protection Agency quietly strangles domestic energy production through difficult-to-understand rulemaking processes; — 8 — Mandate for Leadership: The Conservative Promise l Bureaucrats at the Department of Homeland Security, following the lead of a feckless Administration, order border and immigration enforcement agencies to help migrants criminally enter our country with impunity; l Bureaucrats at the Department of Education inject racist, anti-American, ahistorical propaganda into America’s classrooms; l Bureaucrats at the Department of Justice force school districts to undermine girls’ sports and parents’ rights to satisfy transgender extremists; l Woke bureaucrats at the Pentagon force troops to attend “training” seminars about “white privilege”; and l Bureaucrats at the State Department infuse U.S. foreign aid programs with woke extremism about “intersectionality” and abortion.3 Unaccountable federal spending is the secret lifeblood of the Great Awokening. Nearly every power center held by the Left is funded or supported, one way or another, through the bureaucracy by Congress. Colleges and school districts are funded by tax dollars. The Administrative State holds 100 percent of its power at the sufferance of Congress, and its insulation from presidential discipline is an unconstitutional fairy tale spun by the Washington Establishment to protect its turf. Members of Congress shield themselves from constitutional accountability often when the White House allows them to get away with it. Cultural institutions like public libraries and public health agencies are only as “independent” from public accountability as elected officials and voters permit. Let’s be clear: The most egregious regulations promulgated by the current Administration come from one place: the Oval Office. The President cannot hide behind the agencies; as his many executive orders make clear, his is the respon- sibility for the regulations that threaten American communities, schools, and families. A conservative President must move swiftly to do away with these vast abuses of presidential power and remove the career and political bureaucrats who fuel it. Properly considered, restoring fiscal limits and constitutional accountability to the federal government is a continuation of restoring national sovereignty to the American people. In foreign affairs, global strategy, federal budgeting and pol- icymaking, the same pattern emerges again and again. Ruling elites slash and tear at restrictions and accountability placed on them. They centralize power up and away from the American people: to supra-national treaties and organizations, to left-wing “experts,” to sight-unseen all-or-nothing legislating, to the unelected career bureaucrats of the Administrative State.