GOP is poised to snatch health care from millions

If James Comey, the FBI director, hadn’t tipped the scales in the campaign’s final days with that grotesquely misleading letter, right now an incoming Clinton administration would be celebrating some very good news. Because health reform, President Barack Obama’s signature achievement, is stabilizing after a bumpy year.

This means that the huge gains achieved so far — tens of millions of newly insured Americans and dramatic reductions in the number of people skipping treatment or facing financial hardship because of cost — look as if they’re here to stay.

To appreciate the good news about Obamacare, you need to understand where the earlier bad news came from. Premiums on the exchanges, the insurance marketplaces created by the Affordable Care Act, did indeed rise sharply this year, because insurers were losing money. But this wasn’t because of a surge in overall medical costs, which have risen much more slowly since the act was passed than they did before. It reflected, instead, the mix of people signing up — fewer healthy, low-cost people than expected, more people with chronic health issues.

The question was whether this was a onetime adjustment or the start of a “death spiral,” in which higher premiums would drive healthy Americans out of the market, further worsening the mix, leading to even higher premiums, and so on.

And the answer is that it looks like a one-shot affair. Despite higher premiums, enrollments in the exchanges are running ahead of their levels a year ago; no death spiral here. Meanwhile, analysts are reporting substantial financial improvement for insurers: The premium hikes are doing the job, ending their losses.

In other words, Obamacare hit a bump in the road, but appears to be back on track.

But will it be killed anyway? In a way, Democrats should hope that Republicans follow through on their promises to repeal health reform. After all, they don’t have a replacement, and never will. As a result, repeal would have devastating effects, with people who voted Trump among the biggest losers. Independent estimates suggest that Republican plans would cause 30 million Americans to lose coverage, with about half the losers coming from the Trump-supporting white working class.

Republican congressional leaders like Paul Ryan seem eager to push ahead with repeal.

Why do the Republicans hate health reform? Some of the answer is that Obamacare was paid for in part with taxes on the wealthy, who will reap a huge windfall if it’s repealed, even as many middle-income families face tax hikes.

Obamacare must die precisely because it’s working, showing that government action really can improve people’s lives — a truth they don’t want anyone to know. How will Republicans try to contain the political fallout if they go ahead with repeal, and tens of millions lose access to health care? No doubt they’ll try to distract the public — and the all-too-compliant news media — with shiny objects of various kinds. Obamacare has, in fact, been a big success — imperfect, yes, but it has greatly improved (and saved) many lives. If, as seems all too likely, a health care debacle is imminent, blame must be placed where it belongs: on Donald Trump and the people who put him over the top.