The Difficulty of Repealing Obamacare

Brian Beutler - ObamacareFor seven years now, the mantra “repeal Obamacare” has been both a spasm of revanchist rage and a cynical ploy to keep a segment of the electorate motivated to vote for Republicans. It was also frequently deployed in the belief that the GOP would not be thrust into a position in which those voters could expect them to make good on the promise.

But Donald Trump’s Republican Congress convened only three days ago, and members are already finding that eliminating Obamacare will be far messier politically than devising and implementing it was for Democrats…

Republicans got themselves into this mess at least in part because of a broad, conservative failure to treat Obamacare on its true terms rather than as an evil abstraction conjured by a political foe. In an important sense, there is no Obamacare anymore; there’s just the health care system Republicans are inheriting, and the one they will leave behind…

When Democrats controlled the government in 2009, they could have theoretically passed legislation that opened an existing public insurance system like Medicare or Medicaid to working-age people. But that would have unspooled existing insurance markets, creating significant disruption for consumers and relentless opposition from carriers and other powerful interests.

Democrats instead struck bargains with stakeholders across the health industry, which created political and economic space for a major coverage expansion but left most existing arrangements untouched. They subjected insurers to more regulation, but guaranteed them millions of new customers; they cut reimbursement rates to hospitals, but with the understanding that a spike in insured patients would help them recoup lost revenues. Most of those patients were expected to be poor people who would be added to state Medicaid rolls, in an expansion paid for almost entirely by the federal government.

The political downsides to this approach were fairly obvious at the time, and have become more clear as the law’s been implemented. It’s complex and inequitable; it doesn’t cover everyone; it turns people into customers in an amoral and unpopular market, rather than into users of a simple public utility. But the upside was that it could be slowly blended into the existing fabric of the health system without rending the whole thing and starting over. It’s not a single patch in a strange patchwork. Removing the stitching won’t just re-create a hole, but leave the rest of the quilt more tattered than it was before.

–Brian Beutler
Republicans Want Revenge for Obamacare and It’s Making Them Do Stupid Things

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