An alternative to “repeal and delay”

There is a growing realization on the right and left that repealing Obamacare with the promise that something better will come along would be a policy and political disaster. Insurers would accelerate their withdrawal from exchanges, heightening the demise of the exchanges. Individuals would lose coverage, health care horror stories would spread like wildfire, and the GOP would pay an awful price.

There are two alternatives: 1) Repeal and replace all at once; or 2) Grandfather everyone.

The first is the most logical. Republicans say they have a better way. Let’s see it and find out if they can pass it. Truth be told, they don’t have agreement among themselves, let alone with Democrats. In that sense the “repeal and replace” promise is fraudulent. If they cannot replace it, don’t promise to repeal it.

The next alternative comes from conservative health care guru James Capretta of the American Enterprise Institute:

He argues the GOP shouldn’t push people out of the insurance under ACA. If Congress established a new system of insurance coverage, over time there would be a natural transition from the ACA to the replacement plan. Such a transition would allow those enrolled in an insurance plan offered on the exchanges to continue to be eligible for those plans, with ACA’s premium subsidies provided. It would also mean allowing all those who became eligible for Medicaid, because of the ACA expansion of the program, to remain there, even if a replacement plan later lowers eligibility levels for prospective Medicaid applicants.

“Allowing people to keep what they have today on an indefinite basis will help stabilize the marketplace and allow for an orderly, rather than a chaotic, transition,” Capretta says.

But what about, say, the 27 year old who comes off his parents’ plan in 2017? What about someone who starts working full time, increasing her income beyond the Medicaid cutoff ? We should want her to keep working, so let’s give her the benefit of the subsidized exchanges also. The person who loses his job and falls into the income level covered by Medicaid? We don’t want him to be deprived of coverage when others who happened to lose their job and got the benefit of expanded Medicaid gets theirs, do we? That would be perversely unfair.

Yeah, we kinda fudged in suggesting grandfathering was a stand-alone option.

Until the GOP can pass something with bipartisan support and solves the ACA problems it has identified, it should do nothing. The ultimate “grandfathering” — leave the system in place. That is the only real solution politically or policywise that doesn’t create a raft of victims. The sooner the GOP figures this out, the better.