Don’t repeal and replace — retain and repair Obamacare
Scrambling for votes on their wildly unpopular health care bill, Senate Republicans find themselves with an unappealing choice. They can anger their base by ditching seven years of promises to repeal Obamacare. Or they can strip 22 million people — more than the population of Florida — of their health coverage.
On a moral basis, this is not a close call. And even as a political calculation, ramming through a plan supported by just 12% of the public doesn’t look like a brilliant move.
When Republicans come to see this, they will be in the market for an exit strategy. Might we suggest one: Instead of just letting the matter drop, they should work to fix the flaws in Obamacare.
The way to start the process is simply to remove some of the uncertainty swirling around the future of the Affordable Care Act. Insurance companies hate unpredictability, which has prompted them to stop offering individual policies on some state exchanges.
To this end, the Trump administration should stop sabotaging Obamacare by threatening to block cost-sharing subsidies for insurers. The administration should also make clear that, as long as Obamacare is in effect, the requirement that all Americans have insurance will be enforced.
After that, legislative options include:
Increasing the penalties for not having insurance. This promotes personal responsibility and prevents people from waiting until they get sick to buy insurance. The more they do that, the more insurers hike their prices and pull out of markets entirely. Today’s annual penalty is as low as $347.50 for a child under 18.
Increasing subsidies and tax breaks for having insurance. Obamacare is in much the same position that Medicare Advantage, a private option for seniors, was in the early 2000s. The problem went away when Congress decided to be more gener- ous. The case for Obamacare is much stronger, as its customers don’t have traditional Medicare to fall back on.
Allowing Medicare to negotiate drug prices. While not directly related to Obamacare exchanges, this change would free up as much as $121.3 billion over 10 years that could be used on subsidies. It would also help hold down drug costs across the board.
Bringing back the public option. The idea of a government insurance plan alongside private ones was nixed when Obamacare was debated in 2009. But the argument for it grows stronger when private insurers won’t sell insurance at any price in some parts of the country. The public option could be limited to regions lacking private options.
If Republicans don’t repeal Obamacare, they will take a hit from true believers within their party. But they are better off taking their medicine now and planning on a healthier future.
They might as well reach out to swing voters — and many Republicans who’ve come to realize how important Obamacare is to their communities — by fixing the program’s faults. Repealing the Affordable Care Act, and adopting a wholly unsuitable replacement, is likely to pave the way for a singlepayer, Medicare-for-all system that Republicans will dislike even more than they hate Obamacare.