Poll: Amer­i­cans back parts of Oba­macare, dis­like ‘man­date.’

New ‘mar­ket-ori­ented’ plan fa­vored by Trump

The Washington Times Daily - - FRONT PAGE - BY TOM HOW­ELL JR.

Amer­i­cans sup­port Oba­macare’s key ben­e­fits but still loathe the “in­di­vid­ual man­date” re­quir­ing them to buy in­sur­ance — the key to mak­ing the law’s eco­nomics work — ac­cord­ing to a new poll that un­der­scores the dif­fi­culty Repub­li­cans face in try­ing to re­peal it.

More peo­ple still dis­like the Af­ford­able Care Act than ap­prove of it, by a 45-43 mar­gin, ac­cord­ing to the Kaiser Fam­ily Foun­da­tion’s sur­vey taken after the Nov. 8 elec­tion.

The elec­tion put the GOP in con­trol of both cham­bers of Congress and the White House, clear­ing the way for them to make good on their prom­ise to re­peal and re­place the 2010 law.

“We need to give the Amer­i­can peo­ple re­lief from Oba­macare,” Speaker Paul D. Ryan, Wis­con­sin Repub­li­can, said Thursday, say­ing dwin­dling choices and ris­ing pre­mi­ums un­der the pro­gram are “re­ally hurt­ing fam­i­lies.”

Yet only a quar­ter of Amer­i­cans want Pres­i­den­t­elect Don­ald Trump and the next Congress to fully re­peal the law, the Kaiser poll found, driven by a post-elec­tion shift in at­ti­tudes among Repub­li­cans. Just over a ma­jor­ity of them seek re­peal, com­pared to nearly seven in 10 in Oc­to­ber, while the share of Repub­li­cans who want law­mak­ers to scale back what the law does jumped from 11 per­cent to 24 per­cent.

Mr. Trump has said he wants to pre­serve a pair of Oba­macare pro­vi­sions that en­joy ma­jor­ity sup­port from Repub­li­cans and Democrats alike — al­low­ing young adults to stay on their par­ents’ in­sur­ance plans un­til age 26 and bar­ring in­sur­ers from turn­ing away sick cus­tomers.

He’s also en­dorsed Repub­li­can ef­forts to use “mar­ket-ori­ented” re­forms to en­tice peo­ple into plans in­stead of us­ing the in­di­vid­ual man­date that was in­cluded in Oba­macare to prod healthy peo­ple into its web-based ex­changes.

Yet the Obama ad­min­is­tra­tion and its pro­gres­sive al­lies say that’s eas­ier said than done. They said Repub­li­cans will strug­gle to fid­dle with the “three-legged stool” ap­proach: re­quir­ing in­sur­ers to cover cus­tomers who are al­ready sick, us­ing the man­date to force healthy cus­tomers to bal­ance out the sick ones, and then of­fer­ing tax­payer-funded sub­si­dies to help cover some of the costs.

“I think Repub­li­cans are fig­ur­ing out how hard it is, both po­lit­i­cally and from a pol­icy per­spec­tive, to re­peal the Af­ford­able Care Act. If you try to re­peal the man­date and the sub­si­dies, while keep­ing the ban on dis­crim­i­na­tion against sick peo­ple, the whole in­sur­ance mar­ket col­lapses,” said Sen. Christo­pher Mur­phy, Con­necti­cut Demo­crat. “I think they’re in an im­pos­si­ble po­si­tion given Trump’s com­ments be­fore and after the cam­paign.”

Repub­li­cans ar­gue the man­date was not only un­pop­u­lar but in­ef­fec­tive in hold­ing pre­mi­ums down.

Sen. Cory Gard­ner, Colorado Repub­li­can, said there is emerg­ing con­sen­sus on how the GOP can pre­serve the as­pects of health care re­form that peo­ple like but with­out re­sort­ing to oner­ous man­dates. That in­cludes age-based tax cred­its to help poorer peo­ple ob­tain cov­er­age while pro­vid­ing fed­eral fund­ing for high-risk pools to sup­port sicker con­sumers who’ve been priced out of cov­er­age.

“I think el­e­ments of those have been a part of ev­ery re­place­ment plan put for­ward,” Mr. Gard­ner said.

The House GOP’s “Bet­ter Way” plan would en­tice con­sumers into cov­er­age by al­low­ing them to shop across state lines and use tax cred­its on any plan they want in­stead of ones that meet min­i­mum cov­er­age re­quire­ments from Wash­ing­ton.

Yet bridg­ing the di­vide be­tween re­peal and re­place is al­ready pos­ing a chal­lenge for Repub­li­cans, who must de­cide whether to fi­nal­ize an Oba­macare al­ter­na­tive be­fore they kick-start ef­forts to ful­fill their cam­paign vow and dis­man­tle the law.

Two-thirds of Amer­i­cans who want Congress to re­peal Oba­macare want to see it re­placed, ac­cord­ing to Kaiser, with 42 per­cent of them say­ing law­mak­ers should have a re­place­ment in hand, with 21 per­cent say­ing the re­place­ment can come later.

Sen. La­mar Alexan­der, a Ten­nessee Repub­li­can who is chair­man of the Health Com­mit­tee, said he wants to see re­peal and re­place hap­pen at the same time.

Yet House Ma­jor­ity Leader Kevin McCarthy sug­gested this week that Congress could re­peal im­me­di­ately, with a “tran­si­tion” pe­riod to al­low time for con­sen­sus on an al­ter­na­tive.

He said re­peal only takes a ma­jor­ity vote, us­ing bud­get fast-track rules, while re­place­ment would likely need to achieve 60 votes to head off an ex­pected Demo­cratic fil­i­buster.

Re­peal­ing first could also force Democrats to the ne­go­ti­at­ing ta­ble if they’re given a dead­line to tran­si­tion.

Some Democrats are al­ready spoil­ing for a fight, how­ever, warn­ing Repub­li­cans that they’ll be re­spon­si­ble if in­sur­ers ditch a po­lit­i­cally doomed law be­fore Congress fig­ures out how to cover the mil­lions of peo­ple in the ex­changes.

“This idea that you can re­peal the Af­ford­able Care Act and post­pone its ef­fec­tive date for two years is likely a fic­tion,” Mr. Mur­phy said. “The mar­kets will be­gin to un­ravel and col­lapse.”

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