OBAMACARE REPEAL FEVER
Are Republicans ignoring obvious fixes, or are they stuck with a disastrous mess?
David: When the Republican alternative to Obamacare looked dead, Senate Majority Leader Mitch McConnell, as much a representative of the GOP establishment class as you will find in Washington, and President Trump, leader of the populist rebellion, agreed that Republicans needed to repeal the Affordable Care Act now and come up with some kind of alternative later.
That lasted a few hours before moderate GOP senators killed it. Some Republicans saw redemption in failure. Conservatives would be able to say they stood by their principles and fought Obamacare. Swing state senators wouldn’t have to vote to kill the law. Everybody wins!
That didn’t last, either. Republican voters were going to rebel. Anger at party leaders who fail to deliver on election-year promises has become the animating force in GOP politics. It is the reason why Republican voters failed to back both moderates such as Jeb Bush and conservative ideological warriors such as Sen. Ted Cruz last year.
Trump wasn’t going to sit still, either. Remember, Donald Trump is not a conservative Republican. Old men don’t suddenly become principled ideological conservatives. Trump latched onto the Republican Party because it was the easiest tool to bring his brand into politics. If the man who sold himself as a winner who rejects business as usual starts looking like a business-as-usual loser, there’s no reason to expect Trump to stay loyal to the party and the politicians he used to get here.
Now, Republican senators are holding talks to revive their plan based on one principle: maximizing political cover.
Jill: I’m not sure this is how you go about maximizing political cover. The GOP is destined to be known as the party that tried really hard to take away your health insurance. Who is that going to help? House Republicans who voted for a cruel bill might be spared hard-core conservative primary opponents, but they’ll be playing very difficult defense in their general elections. The
dragged-out Senate mess has mainly functioned to keep alive the (true) fact that Republicans planned to throw millions off insurance in order to give tax cuts to the rich.
Leave it to Trump, of course, to set insurmountable bars for irresponsibility, inaccuracy, callousness, fantasy and hypocrisy — all in one news conference at the White House:
Obamacare is “a total disaster” — totally false.
“Let Obamacare fail” — sure, stand by and watch as insurance markets, people’s nerves, their finances and in some cases maybe even their health go into the fabled “death spiral.”
“I’m not going to own it. I can tell you the Republicans are not going to own it” — wanna bet? Good luck with that given the GOP controls the White House and Congress.
It is very important to remember the bottom line here, and that is people and their health, their finances and their productivity. Why would we want to stop progress on all that in its tracks?
What happens now appears to hinge largely on three Republican women, Sens. Susan Collins of Maine, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska, who are protective of Medicaid and against repeal without replace. All three were cut out of the all-male working group that came up with these genius proposals. As Abigail Adams would have said, “Remember the ladies.” Or else.
David: I won’t defend Republican replacements for the Affordable Care Act. I could never follow the details because half the time, they were secret, and the rest of the time, the GOP was flitting from plan to plan. You can’t build public support if you don’t stick to a plan long enough to explain it.
Even so, the idea that Obamacare created some kind of health care utopia is a little hard to swallow. Before Trump even set foot in the Oval Office, the program was coming apart.
Insurers were withdrawing from markets all over the country. Last August, the Kaiser Family Foundation was predicting that in 2017, there would be two or fewer insurers in 60% of U.S. counties, and one or even zero in 30%. Competition was already collapsing. And that hit voters’ wallets. Last October, ACASignups.net was reporting that average Obamacare premiums were going up by 25% for 2017.
That kind of unsustainable inflation is what President Obama promised he would stop. “We agree on reforms that will finally reduce the costs of health care,” Obama said in 2009. “Families will save on their premiums; businesses ... will save money now and in the future.”
And all that leaves aside the question of insurance deductibles. Americans are shelling out thousands to pay for coverage that doesn’t really kick in until they spend thousands on uncovered medical bills.
The fact is that when the nonpartisan Congressional Budget Office looked at Republican plans for replacing Obamacare, the No. 1 reason that privately insured folks would “lose” coverage is because the Republican plan would no longer penalize people for not buying insurance. It doesn’t sound to me like the beneficiaries of Obamacare are fans of the plan if we have to force them to buy in.
The Republicans may have blown the politics of health care, but Democrats left us with a disastrously unstable system without any obvious fix.
Jill: There is a lot left out of these arguments, starting with sabotage of the ACA by many Republican governors and the entire congressional GOP. There could have been more competition, cost control and subsidies had Republicans tried to make the law work instead of trying in many cases to make sure it failed. Kaiser now reports that the insurance market is stabilizing, that companies are becoming profitable, and that there is “no sign of a market collapse.” This is despite the chaotic signals coming from Trump and Washington.
A large-scale study of Ohio’s Medicaid expansion to more than 700,000 people found that the coverage had improved their health and financial situations. In fact, the bankruptcy rate has plummeted since the ACA took effect, a development attributed largely to a drop in medical bankruptcies.
As for what’s driving the drop in insured projected by the CBO, that number would be 15 million in 2018, and most indeed would be people who didn’t buy insurance because the requirement to buy it was gone. But in 2026, when 22 million fewer people would be insured, Medicaid cutbacks would account for 15 million of them.
There are obvious fixes to many of these problems, and they invariably involve money: how much you spend and how you decide to spend it. There are answers, even some that both parties could live with. But first, Republicans need to get repeal fever out of their system and reopen their minds to working with Democrats.