GOP Can Destroy Obamacare Even Without A Repeal Vote
Democrats are plotting on how they might best be able to defend Obamacare with Obama himself meeting with top Democrats today to figure out their best options. Democratic leaders are being urged to hold Republicans to account for earlier statements that gave the impression that the transition from repeal to replace could be smooth. Nancy Letourneau over at Political Animal wants to hold Paul Ryan to his word that “no one will be worse off” during the transition and she’s listed nine parameters by which we can measure Ryan’s promise:
- 20 million people have access to affordable coverage via the exchanges and Medicaid expansion.
- You cannot be denied coverage due to a pre-existing condition.
- Medicare spending was reduced by $802 billion over 10 years.
- Obamacare closed the Medicare prescription drug donut hole by 2020.
- Regardless of whether your health insurance is via your employer, Medicare, Medicaid, the exchanges, or the individual market, you have access to free preventative services – including annual exam, birth control and screenings for breast and colorectal cancer, heart disease and diabetes.
- Children under 26 years of age can stay on their parent’s health insurance plan.
- There are no annual or lifetime limits on what insurance plans will cover.
- If insurers charge more than 15% for overhead/profit (20% on the individual market), they are required to provide you with a refund.
- Women cannot be charged more for insurance than men.
“And now comes the reality of the ‘repeal and replace’ initiatives from the Republicans. If the uncertainty of this market was large before with the ACA, it is almost unknowable under whatever comes next. Thus the initial exit of some latecomers, including United Healthcare, and undercapitalized minor entrants, such as nonprofit co-ops, is almost certain to become a flood of firms leaving the exchanges. They have little choice since the risks are too large and the actuarially appropriate rates are still not obvious given the political turmoil and changing rules. Some in Congress seem to think that passing the ‘repeal’ part immediately but delaying its implementation for two or three years will somehow leave everything as it is now. But this naive notion misses the fact that the riskiness of the Obamacare individual insurance exchange markets will have been ramped up to such a level that continuing makes no sense. Even if a company reaches break-even in the ‘delay’ years, it will lose when the repeal is effective. If the premium subsidies now available to lower-income enrollees go away immediately and the mandate to sign up for an insurance plan disappears, then the number of people purchasing individual policies on the exchanges will drop like a rock. In fact, it is clear that even debating this scenario is likely to be self-fulfilling, since insurers must decide on their participation for 2018 by the late spring of 2017. Look for many to leave then.” (Emphasis mine).
Silver believes that the mere discussion of repeal and replace or repeal and delay by Republicans will effectively destroy Obamacare in 2018. So, in fact, Republicans don’t have to do anything but jawbone about repealing Obamacare and they will destroy it. In fact, by not actually doing anything other than talking about repeal, Republicans could reasonably argue that Obamacare collapsed on its own. There would be no need for a vote to repeal. Luckily for Democrats, it seems that Trump and most Republicans feel they have to actually vote on repeal. But I wouldn’t bet that the evil Mitch McConnell allows a couple of GOP Senators to join with Democrats in blocking that repeal sometime early this summer. By that time, enough insurers may have already backed out for 2018 that repeal would be moot but Republicans will not “own” it.
If that hypothetical were to come to pass, Democrats would have to do some serious thinking about what to do. Do you allow the GOP to kill Obamacare silently or do you allow a couple of red state Senators to vote to kill Obamacare and try to make the Republicans own. Either option is terrible. But when Obamacare is repealed, either by stealth or a vote by the GOP, Democrats ought to use the opportunity to say that the private market is obviously unreliable for providing health care for all segments of the American market and that only a public option will do. The death of Obamacare gives progressives and Democrats to draw a line in the sand for any future replacement. And that line is the public option.