Winning is easy; governing is hard.
It is easy to get people – especially Republicans — to hate Obamacare. For one thing, it has the name of the 44th President attached to it. That alone gets many people to dislike it.
On top of that, it DOES have many problems. Rates this past year jumped bigly, and many plans now have high deductibles. (To be fair, the health-care premium increased 31% from 2006-2011, pre-Obamacare, and only 20% with Obamacare over the 5 year period of 2011-2016 — but some states have been hit hard.)
Also, in many counties now, there is only one choice of healthcare plan.
But the Affordable Care Act (see, it’s not Obamacare now!) is not the “total disaster” that Trump says it is. About 16.6 million people now have health insurance — people who wouldn’t have it otherwise. Denial of insurance because of pre-existing conditions is a thing of the past.
The ACA also allows states to expand Medicaid eligibility, with the federal government paying most of the cost for new beneficiaries.
Finally, the ACA also prohibits insurers from charging different premiums to individuals based on their health. Everyone is in one big insurance pool, sharing in the average cost. Tax credits to help people buy private insurance.
The problems hit because more sick people enrolled than insurers expected when they initially set their premiums in 2014. That’s a big reason why premiums are rising more quickly for 2017 — with benchmarks increasing 22% on average nationally and 8% in California. Some insurers have exited the market, and Obamacare consumers face fewer choices. But the hope is that these higher premiums represent a one-time market correction rather than a sign of worsening trends to come.
The problem is, what happens when the GOP tries to change the ACA?
That, of course, depends on HOW they do it, and what they replace it with. All indications are that they want to keep the popular parts of the ACA (the ban on pre-existing conditions, and the part where you can be on your parents’ plan if under age 26), but remove other parts (the individual mandate which penalizes people who don’t buy health insurance).
And how will they do this? It looks like they may use a budget maneuver known as a reconciliation bill, and through this, repeal parts of the ACA. The advantage of such a bill is that it cannot be filibustered in the Senate, meaning it can be passed with 51 votes instead of 60. The disadvantage is that it can be used only to make changes that have a direct effect on federal spending or taxes. So, for example, a reconciliation bill cannot repeal the ACA’s insurance market regulations, including protections for people with pre-existing conditions. But it can repeal the law’s premium subsidies and the individual mandate.
Unfortunately, this is going to wreak havoc and produce a death spiral in the individual health insurance market. With guaranteed insurance for people with pre-existing conditions but no subsidies or individual mandate, premiums could skyrocket. Or, more likely, insurers simply would exit the market. Why risk losses when the whole law is getting repealed anyway? The upshot would be canceled coverage with no other options for people buying in the ACA’s marketplaces (like healthcare.gov or Covered California), as well as those buying directly from insurers, where the same rules apply.
So what Republicans MUST do is hold off on the reconciliation bill until they have a replacement in mind for the ACA. That presents a political problem though, because repealing Obamacare was designated a first priority.
In short, here’s the dilemma for Republicans: YOU HAVE TO HAVE THE INDIVIDUAL MANDATE IF YOU WANT TO KEEP THE BAN ON PRE-EXISTING CONDITIONS. Period. It’s that simple. If you don’t, then premiums will go through the roof, since people will drop their insurance and insurance companies won’t have the money to cover all the people with pre-existing conditions.
The only other alternative? Single payer. But the GOP won’t touch that.
So the GOP is in a bit of a bind. Maybe that’s why this happened:
In a Tuesday letter to congressional leaders, the American Medical Association (AMA) came out against plans floated by Republicans to quickly repeal Obamacare but delay fully replacing the law.
The AMA told congressional leaders that they must reveal their plans to replace the Affordable Care Act before repealing the legislation.
“[W]e believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform,” James L. Madara, the CEO of the AMA wrote in the letter.
The GOP, no doubt, wants to dismantle Obamacare but doesn’t want to get the blame. The ball is definitely in their court. They’re like the dog that caught the bus by the bumper — not sure what to do.
But it ain’t looking good for the dog.