“Re­peal­ing” Obamacare

The Denver Post - - OPINION - By Ramesh Pon­nuru

Long be­fore Obamacare, the fed­eral govern­ment had been sub­si­diz­ing health in­sur­ance for scores of mil­lions of Amer­i­cans. The law ex­panded that sub­si­diza­tion to cover sev­eral mil­lion more peo­ple.

If that’s all it had done, it might have got­ten some Repub­li­can sup­port: Forty Repub­li­cans in the House and seven in the Se­nate voted to ex­pand the Chil­dren’s Health In­sur­ance Pro­gram in the first weeks of Obama’s pres­i­dency.

But the Obamacare law also, for the first time, made the fed­eral govern­ment the chief reg­u­la­tor of health in­sur­ance. And these reg­u­la­tions are re­spon­si­ble for nearly all the up­roar about the law. It’s the reg­u­la­tions that caused peo­ple to lose their health in­sur­ance, con­trary to Obama’s if-youlike-it-you-can-keep-it prom­ise. It’s the reg­u­la­tions that have led to high pre­mi­ums for many plans. It’s the reg­u­la­tions that have un­der­mined the vi­a­bil­ity of the govern­ment’s health ex­changes.

Yet many Repub­li­cans, Philip Klein reports, are con­sid­er­ing mov­ing quickly next year on a bill to “re­peal” Obamacare with­out touch­ing its reg­u­la­tions. They hope that the Trump ad­min­is­tra­tion uses ex­ec­u­tive power to loosen those reg­u­la­tions sub­se­quently. But many of the most prob­lem­atic reg­u­la­tions — like the ones set­ting a ra­tio for the pre­mi­ums that can be charged for the young com­pared to the old — are in the law it­self, and can­not le­git­i­mately be mod­i­fied that way.

The Repub­li­cans are think­ing of leav­ing Obamacare’s reg­u­la­tions in place be­cause they fear that a bill al­ter­ing them would die in a fil­i­buster. They are sure they can use a pro­ce­dure for avoid­ing fil­i­busters if they tar­get only the law’s tax and spend­ing pro­vi­sions.

This course could cause the in­sur­ance ex­changes, al­ready in trou­ble, to col­lapse en­tirely. That’s be­cause the Repub­li­can bill would scrap the in­di­vid­ual man­date while keep­ing Obamacare’s re­quire­ment that in­sur­ers treat sick and healthy peo­ple alike.

The in­di­vid­ual man­date ex­ists be­cause Obamacare’s ar­chi­tects un­der­stood that this re­quire­ment, on its own, gives healthy peo­ple a rea­son not to buy in­sur­ance: They can wait un­til they get sick and buy it. But the more that healthy peo­ple avoid in­sur­ance, the higher pre­mi­ums will have to be — and as they go higher, even more healthy peo­ple will stop buy­ing cov­er­age. In­sur­ance mar­kets can’t work that way.

The Repub­li­cans to whom Klein talked are blasé about this pos­si­bil­ity. If mil­lions of peo­ple lose their cov­er­age, these Repub­li­cans plan to say that the ex­changes were al­ready col­laps­ing be­fore they touched the law. It seems un­likely that the press will go along with this nar­ra­tive, in part be­cause many health-care ex­perts, lib­eral and con­ser­va­tive, will tell re­porters that it’s false.

What Repub­li­cans have not faced is that they don’t have the votes to re­peal Obamacare. Call­ing a bill that doesn’t re­peal Obamacare’s cen­tral pro­vi­sions “re­peal” is no es­cape from that dilemma.

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