In 2010, angry Americans elected Republicans to the House of Representatives in the belief that Republicans would fight tooth and nail to repeal Obamacare. In 2014, Republicans took the Senate by making the same promise. In 2016, President Trump won election on the basis of repealing the “disaster” of Obamacare.
Now it’s 2017. Republicans have a majority in the House and Senate. President Trump is in the White House.
And instead of repealing Obamacare, they now plan to trim around the edges.
Their new Obamacare plan isn’t an attempt to shift America away from government-run healthcare. It’s an attempt to re-enshrine government as the center of the health care system, with a slightly rejiggered vision of its role. The plan isn’t likely to lower costs, promote competition, or curb moral hazard.
It’s not good.
Here are the five biggest problems:
1. It Retains Requirements That Insurance Cover People With Pre-Existing Conditions. The key component to Obamacare was always the nonsensical notion that government could force insurance companies to cover those with pre-existing conditions. This turns insurance companies into piggy banks rather than insurance companies – imagine a fire insurance company that allowed you to buy insurance after your house was on fire. That’s not an insurance company anymore. The same is true in health insurance – and the Republicans’ attempt to preserve this popular provision of Obamacare means that Republicans must also do something to ensure that insurance companies don’t go bankrupt. There are only two ways to do that: with a mandate to buy insurance, or with government subsidies.
2. It Creates A Back Door Mandate. The Republican plan gets rid of the overt Obamacare mandate. But it does allow insurance companies to charge an elevated 30% fine for those whose insurance lapses for more than two months at any point in the last 12 months. This means that you’re essentially fined in the future for not buying insurance now. Which has nothing to do with the Constitutional role of government.
3. It Creates Individual Healthcare Subsidies. The problem is that this back door mandate isn’t enough. What about people who are high risk or have pre-existing conditions, but haven’t bought insurance? We have to give them money to buy health insurance. Which is what the bill does: it includes an advanceable, refundable tax credit based on age. This is effectively a subsidy, since the tax credits apply to people who don’t pay much in taxes, just as the Earned Income Tax Credit is actually a giveaway to people who don’t pay taxes.
4. It Subsidizes Medicaid. The Obamacare boondoggle was sold by allowing the federal government to pick up the tab for Medicaid expansion in the states. This bill would allow the feds to cover Obamacare Medicaid expansion for three years – and there’s no way a future Congress will actually cut these subsidies, fearing political backlash. This is like every other long-promised sunsetted spending program: it’s not going anywhere.
5. It Subsidizes High-Risk Pools On The State Level. The bill sends $100 billion to states over the next ten years to help cover those who are high risk and can’t afford insurance. This, of course, won’t be nearly enough – it incentivizes the state to sign people up, then look to the federal government for more cash.
The bill does have good points – it’s revocation of Obamacare taxes and sponsorship of Planned Parenthood are great. But it doesn’t do any of the key things Republicans would want to do, and it actually ends up allowing Democrats to keep most of what Obama created while simultaneously blaming Republicans for its shortcomings as well as the budget blowout that will follow Republicans killing both the individual mandate and the Cadillac tax.
So, well done, Republicans. Instead of putting forward a gradual repeal of Obamacare, you’ve actually created a gradual cementing of key elements of Obamacare, all to avoid the political blowback.