Obamacare Is Ill, But GOP's Repeal/Delay Is No Rx

Obamacare Is Ill, But GOP's Repeal/Delay Is No Rx
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The long-awaited time of reckoning is here for Obamacare: Republicans are poised to fulfill their loudest political promise and repeal it. Too bad that instead of a new plan they only have a political gimmick that could actually make things far worse.

Republicans are trumpeting their new united government, but despite the election of Donald Trump and control of both chambers of Congress they are nonetheless divided on an issue the party has coalesced around since 2010. After six years of criticism and pledges to fix the broken health care law, they have no remedy ready. There is no consensus on who gets covered or how to pay for it, and Trump’s often conflicting statements have only steepened their challenge.

Trump insisted during the primary campaign he would not “allow people to die in the streets,” has pledged repeatedly to repeal and replace the law but also wants to keep sick patients on the rolls and keep children on their parents’ plans until they turn 26. The mandate to purchase insurance, which funds costly coverage of the sickest, is anathema to conservatives but Trump once said he loved it. During a primary debate he promised this: “You’re going to see pre-existing conditions and everything else be a part of it, but the price will be down, and the insurance companies can pay. Right now they’re making a fortune.”

Since they have the votes to repeal, but not to reform, the Affordable Care Act, Republicans are opting for a cheap sugar high that allows them to end the law three years from now with a vote in early January. But their “repeal-and-delay” plan, what House Speaker Paul Ryan calls “Obamacare relief,” will likely hasten the law’s collapse and leave those enrolled with scant but unaffordable coverage.

The truth is the death spiral has already begun for Obamacare, and a political vote could hurt millions of people who are likely the sickest. Insurers such as Aetna and UnitedHealthcare have already left most of the exchanges, and patients are paying more for far less. News of the ghastly premium price hikes announced in October -- 116 percent in Arizona and 53 percent in the swing state of Pennsylvania, which Trump won -- had begun to dent Hillary Clinton’s polling leads against Trump even before FBI Director James Comey released his infamous letter to Congress.

Once Congress sunsets the entire law, the response from insurance companies will be to continue pulling out, likely right away, experts say. Healthy people with options would likely opt out, fewer new people will sign up and only the sick would remain, making the coverage more expensive than ever.

The symbolic vote may feel great for Republicans and even for many of their voters, but it’s not only a threat to the health of those enrolled, it’s a self-inflicted political trap as well. Their plan is to use the “reconciliation” process in the Senate budget vote to repeal the law, as that would require only 51 votes. Yet once repealed, with a three-year expiration plan, any new reforms will require the help of Democrats to meet the 60-vote threshold needed in the Senate by 2020. House Majority Leader Kevin McCarthy predicted the deadline would bring people to the table, saying that with “a date certain that something’s going away ... you know you have to have something done.” Republicans like McCarthy think Democratic senators up for re-election in 2018 in states Trump won will have to come around and help the GOP pass a bill. “The blame will fall on people who don’t want to do anything,” he said.  

But it sounds as if Democrats aren’t feeling so bipartisan. “They’re going to find repealing Obamacare without putting in a replacement will be far more disastrous and less clever than they think,” incoming Senate Minority Leader Chuck Schumer said on CNN last week. Patty Murray, another Democratic leader in the Senate, put it more bluntly: “If they break this, they own it.”

Sounds bleak, but then again it has been a while since we’ve been pushed to a cliff like this, where Congress deadlocks and fails to find a compromise the deadline is supposed to push them into. Indeed, given a divided Republican Party facing stiff Democratic opposition -- and throw in the consistency of Trump’s inconsistency – and you can see the birth of Sequester II, health care edition, just in time for the next presidential election in 2020.

Someone needs to tell Trump and the Republicans that, yes, there is actually something worse than Obamacare.

A.B. Stoddard is associate editor of RealClearPolitics and a columnist.

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