Since the election of Donald J. Trump I’ve been quite vocal about the dangers of writing about our incoming
Dictator President-Elect. The reasons for which should be obvious to anyone who didn’t vote for the man. I, like many writers interested in staying out of the gulags bad graces of our incoming leader have been highly reticent about saying what I actually think about the upcoming demise greatness of American democracy. Unfortunately, like many blessed with the wisdom of foresight, I simply cannot keep my mouth shut. There are so many things to talk about with the incoming politburo administration that for most it would be difficult to know where to start. I, however, have been giving this quite a bit of thought and know exactly where I want to start: Obamacare.
Earlier this week, five Republican Senators together with House Conservatives pushed a bill that would delay the deadline to “repeal and replace” Obamacare from the 24th of January to March 1st. This is a big deal because conservatives never really wanted to “replace” the Affordable Care Act. They wanted to dismantle it and give tax cuts to people who bought insurance. House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell coalesced around a plan known as Repeal and Delay, a plan that scared the bejesus out of the health care industry largely because it would leave between eighteen and twenty million people without health insurance. What’s more is that this led to a prevailing belief among rank and file Republicans that there was no replacement strategy. Today, Senator Lamar Alexander (R-TN) came out with a proposal that some generously call Obamacare-lite.
Congressman Charlie Dent (R-PA) had this to say about the law yesterday: “Most of us think that aspects of this law need to be repealed. Certain parts need to be reformed and overhauled, some things need to be replaced and other things are going to be maintained.” If that sounds like an attempt at political ju-jitsu that’s probably because it is. Republicans made a clear error in messaging early on when they essentially said that the twenty million Americans who have received coverage under the Affordable Care Act would not lose coverage. Sen. Lisa Murkowski (R-AK) puts it this way: “The thought that we would take away what they are seeing now, whether it’s the benefits they are getting from Medicaid expansion, the subsidies they are getting on the individual market … there is a lot of anxiety and a lot of uncertainty.” No kidding?
This ‘anxiety’ as Murkowski calls it is a belief that unites both health care recipients and health care providers. The reason that there is concern among lawmakers about this hangs largely around the tax-revenue that is generated by the Affordable Care Act’s Medicaid expansion. That’s why when you look at Lamar Alexander’s proposal on this he keep the Medicaid expansion largely in place. That’s because expanding Medicaid is a smart decision from a public policy position. It helps deal with issues of income inequality and social mobility in a time when many Millenials are having very real trouble transitioning from their parent’s health care coverage to the private market. The Medicaid expansion gives people over the age of twenty-six who don’t yet have employer-based insurance a safe haven from losing health care coverage altogether.
The problem, at least from the prospective of Republicans, is that Medicaid provides really, really good insurance. In fact, the favorability rating of Medicaid is on par with that of Medicare. This is because Medicaid is basically Medicare for poor people. When Democrats were debating the Affordable Care Act one of the most popular amendments that was ultimately abandoned was a ‘Medicaid for All’ idea that was recently championed by former Presidential candidate Bernie Sanders (I-VT.) This idea would make health insurance provided by the government more advantageous for those without employer-based insurance than anything the private health insurance market could offer. If that sounds like a good solution that’s because it largely is. By offering health insurance to people who don’t have good private insurance plan the government would be increasing competition between public and private markets. This would improve innovation and ultimately lower costs. The reason this is terrifying for Republicans is because it would 1) increase the deficit by offering long-term coverage for low-income Americans and 2) decrease the total amount of participants in private insurance markets.
Let’s go back to this framework being suggested by Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-TN.) The key takeaways from this are:
- No imminent Obamacare repeal
- Saving popular Obamacare provisions through budget reconciliation stop-gap maneuvers
- Continuing cost-sharing subsidies to insurers for covering low-income people
- Maintaining the ban on denying coverage to patients based on pre-existing conditions
- Eliminating the employer mandate
This is the best of both worlds for Republicans. Republicans hate the individual mandate. They truly believe that this is government imposing an unnecessary burden on consumers. If they get nothing else out of this Obamacare fight they will at least get rid of the individual mandate, but it seems unlikely given their current stance on maintaining coverage for the twenty million consumers who’ve gained coverage under the Affordable Care Act that Republicans will be able to accomplish anymore than getting rid of the individual mandate. Why? Because they’re in favor of everything else! Republicans love a lot of things about Obamacare. In fact, as I’ve said as recently as last Friday, all Republicans really want is a change in the name of the law itself.
Think about this logically for a minute. The Affordable Care Act is not nearly as unpopular as Congressional Republicans make it out to be. When you look at these numbers from Gallup you might think: hey, a majority of Americans don’t like the Affordable Care Act.
Look at the individual opinions on what to do about it though. Even among those who disapprove of the law fifteen percent want to keep it. Making the majority view of Americans: “keep in place” or “keep but change significantly.” Only 37% want to fully repeal and replace. That’s a much different view than the one being pushed by Congressional Republicans right now and as Republicans are finding out firsthand, repeal and replace isn’t such an easy strategy to implement. Why? Because a lot of the law is actually pretty popular. The easy strategy for Republicans isn’t “repeal and replace,” but “change and rebrand.” What Republicans don’t like about Obamacare is the “Obama” part. How do you change that? Easy, change the name to something Republicans really like. Call it Freedomcare. I’m not kidding. Call it Freedomcare, leave the rest of the provisions in place and take a poll of Republicans seeing where they sit on the law. My bet is that, if passed by a Republican-majority Congress and signed into law by a President Trump, Freedomcare would have a 60-70% approval rating. That’s why if Republicans simply get rid of the individual mandate that’s considered a win for them. Then they can rename the law and take credit for all the things they like about it while denying Democrats any credit for the individual provisions that make it popular. It’s really smart politics.