For six years, and over the course of five dozen high-profile, low-probability votes, Republicans in Congress vowed to do away with Obamacare.
Republicans denounced the Affordable Care Act as “a crime against democracy” and labeled it “the most dangerous piece of legislation ever passed.” Oklahoma Sen. Tom Coburn went so far as to warn seniors, “You’re gonna die sooner.”
The election of Donald Trump removed the specter of a presidential veto, yet the Affordable Care Act hasn’t been repealed.
Large and boisterous crowds supporting Obamacare at town hall meetings probably are making some lawmakers nervous about the fallout from killing a program that provides insurance for 20 million Americans. Here’s another possible explanation: Despite its shortcomings, Obamacare has delivered on its basic promise — expanding access to health care by reducing the cost of insurance, especially in states such as California that fully embraced the program.
California has reduced its uninsured rate to a record low of 7.1 percent, according to a report issued this month by the Centers for Disease Control and Prevention.
That’s a decline of 9.9 percentage points since the Affordable Care Act took full effect in 2013.
Let those be benchmarks.
Trump and congressional Republicans still say they’re going to repeal and replace the Affordable Care Act. But any plan that results in fewer people having coverage isn’t a replacement. It’s retrenchment. And that isn’t acceptable.
Despite their harsh criticism of Obamacare, Republicans are far from agreeing on any replacement. They have promised to keep the most popular provisions of Obamacare, including protection for people with pre-existing conditions and coverage of dependents up to age 26. There also is GOP support for retaining requirements that insurers cover treatment of mental illness and substance abuse. Targeted for elimination are the financing mechanisms needed for the program to remain viable — individual and employer mandates and subsidies to help low- and middle-income families pay insurance premiums. A proposal to convert Medicaid to a block grant program almost certainly will result in some states raising the threshold for eligibility.
The numbers simply don’t add up.
Hospitals justifiably fear a return to the days of writing off millions of dollars from providing emergency care to uninsured patients, and insurers will have little choice but to drop out of the exchanges — 11 participate in California — if people can wait until they’re sick before buying coverage.
That’s the death spiral Republicans have been predicting since the Affordable Care Act passed in 2010. It could become a self-fulfilling prophesy if insurers conclude that the risk pool that undergirds the insurance market has been, or will soon be, undermined.
No big program is perfect. Republicans have pointed out Obamacare’s shortcomings for years while refusing to work with Democrats on improvements. If it collapses now, some Republicans will point fingers at Obama and claim the program was fatally flawed. But if millions of people who gained access to health insurance suddenly find themselves without coverage once again, many of them are going to blame the people who wrote the cancellation notice.
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