Congress doesn’t need to rush to kill Obamacare

The Progress-Index - - OPINION -

For seven years, Repub­li­cans have yearned to dis­man­tle the Af­ford­able Care Act. Now that they have the chance, they seem wholly un­pre­pared to do it right. Much work is still needed to fig­ure out how to avoid desta­bi­liz­ing the health­in­sur­ance sys­tem. Yet, in their hurry, lead­ers in Congress seem to want to skip that part. What’s the rush?

Repub­li­cans are al­low­ing them­selves just three weeks to de­velop a bud­get bill that would scut­tle Obamacare — end­ing the tax penal­ties on peo­ple who don’t have in­sur­ance, and scrap­ping in­sur­ance premium sub­si­dies for low-in­come Amer­i­cans. Pre­sum­ably, some or all of the fund­ing to states that have ex­panded Med­i­caid cov­er­age un­der Obamacare would also be cut. Con­gres­sional lead­ers in­tend to thus lay the ground­work for those changes but then avoid ac­tu­ally mak­ing them for two or three years — dur­ing which they prom­ise to think up a bet­ter sys­tem.

It’s an un­re­al­is­tic strat­egy, be­cause it would give the young and the healthy an in­cen­tive to drop their poli­cies, and lead in­sur­ers to flee a mar­ket­place un­der­mined by a weak­en­ing risk pool and shrink­ing or dis­ap­pear­ing sub­si­dies. Com­pa­nies can hardly be ex­pected to count on law­mak­ers’ as­sur­ances that they’ll cre­ate a bet­ter mar­ket­place later.

Obamacare has been able to ex­pand the num­ber of Amer­i­cans with health in­sur­ance by at least 20 mil­lion peo­ple and slow the rising cost of health care by ad­dress­ing the sys­tem’s in­escapable eco­nom­ics: The healthy and rel­a­tively af­flu­ent need to carry some of the ex­pense of cov­er­ing the sick and the poor.

In the­ory, Repub­li­cans could cre­ate a suc­cess­ful sys­tem of their own, with con­ser­va­tive char­ac­ter­is­tics. But it’s a com­pli­cated chal­lenge that takes care­ful, sus­tained at­ten­tion. If Repub­li­cans start by send­ing the in­sur­ance mar­ket into a tail­spin, they’ll need to spend pre­cious time — and money — on deal­ing with the con­se­quences.

Repub­li­can lead­ers keep say­ing that Amer­ica demands a quick re­peal. But what makes them think that? In a poll taken after the elec­tion, just 26 per­cent of re­spon­dents said they wanted the en­tire law re­pealed. Even Repub­li­can vot­ers were split: Only 50 per­cent of those who sup­ported Trump were in fa­vor of re­peal.

Repub­li­cans now have the op­por­tu­nity to shore up Amer­ica’s still un­sta­ble health­in­sur­ance sys­tem — ei­ther by amend­ing the Af­ford­able Care Act or cre­at­ing an en­tirely new sys­tem. Ob­vi­ously, fix­ing would be eas­ier, and prob­a­bly more ef­fec­tive, than re­build­ing. What’s ir­re­spon­si­ble would be to de­stroy what ex­ists with no clear plan to re­place it.

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