Don’t repeal and displace
Senate Republicans are struggling to pass an overhaul of the Affordable Care Act. So a few of them — along with President Trump — have resurrected an absurd strategy: repeal, then hope to replace in the future.
“Let’s do clean repeal like we promised,” Sen. Rand Paul, R-Ky., said Sunday on Fox News. “I think you can get 52 Republicans for clean repeal.” He was joined in this refrain by Sens. Ben Sasse, R-Neb., and Mike Lee, R-Utah.
President Trump had tweeted Friday that if Republican senators can’t pass their highly controversial legislation to replace the Affordable Care Act, they should simply repeal the Affordable Care Act first and replace it later. White House officials later underlined Trump’s message, saying “repeal then replace” was indeed an option that Trump would approve.
Trump’s sudden embrace of “repeal then replace” is a surprise. In January he promised the electorate a simultaneous process, and he suggested Congress do repeal and replace together.
Republicans’ frustration with that combined approach is understandable — the health care bill that the Senate is currently negotiating is wildly unpopular.
A June 28 Fox News poll showed that only 27 percent of the U.S. public has favorable opinions of the Better Care Reconciliation Act, which an analysis by the nonpartisan Congressional Budget Office found would cause 22 million people to lose their health insurance by 2026. Fifty-four percent of voters oppose the Senate legislation.
Yet there’s no evidence whatsoever to suggest that simply repealing the Affordable Care Act would be any more popular with voters.
As Congress tries desperately to get rid of it, the Affordable Care Act is actually increasing in popularity with voters. In the same poll, a record 52 percent of U.S. voters approved of it.
The reason is simple — voters don’t want millions of Americans to be abruptly thrown off of their health insurance. They’re unlikely to be convinced that an IOU from congressional Republicans is better than the plan the country already has.
Politics aren’t the only reason for Congress to do away with the dangerous fantasy of “repeal first, replace later.”
As policy, this strategy would also be absolutely dreadful for the country’s physical and economic health.
Health care, as Trump has noted, is complicated. It’s an industry that touches the lives of every American. Its provision can mean the difference between life and death. And, as the country ages, we are spending more and more money on it — its share of the economy is approaching 20 percent.
It’s never going to be easy for congressional Republicans to find a health care solution. The temptation under a “repeal first, replace later” strategy will be for them to never offer a replacement solution at all.
That will mean a return to the bad old days of health care — skyrocketing annual premiums, insurers denying coverage to people with pre-existing conditions.
Congress needs to be responsible. If it’s determined to repeal the Affordable Care Act, it needs to come up with a plan that’s better. If it can’t, Republicans and Democrats should work together to mend, not end, a law that has significantly expanded Americans’ access to health care.