Within hours of assuming the office of the presidency of the United States, President Donald Trump signed an executive order to ease the “regulatory burdens” of ObamaCare. Specifically, the order is designed to roll back the individual mandate. Trump’s action is the opening shot in what promises to be a long war to repeal Obamacare, a law that is collapsing under its own weight. While some Republicans see repeal of the law as an easy question there are minefields that remain.
Some of those difficult questions were brought to the fore by a recent focus group with voters in Philadelphia conducted by the Health Savings Account Council. The group brought a cross section of voters together to discuss congressional efforts to “repeal and replace” the law. The findings should be a stubborn reminder to the Congress that this is no easy task, a warning echoed by Illinois Gov. Bruce Rauner.
In a letter to Congress, officials from the Lincoln State urged Washington to go slow and ensure “certainty and stability” in any changes to Obamacare. The state’s Insurance Director noted, “There is no question that the major structural flaws in the ACA have forced higher insurance rates and separated families from trusted physicians and hospitals. We urge you to provide certainty and stability for health insurance providers and their enrollees in the current plan year and in the future,” the letter states. “Through the failures of the ACA, consumers in particular have faced enough hardships; please ensure that these are not compounded through hasty and/or incomplete action.”
Rauner and his team have their finger on the pulse of the electorate. While Republican politicians has commonly repeated the phrase “repeal and replace,” voters view the phrase with suspicion. Voters respond better to words like “fix,” “improve,” “retool,” and “revise.” There is simple fear that the Congress will repeal the law and people will lose their coverage with nothing left to take its place.
From a policy standpoint, there are other concerns, as well. Obamacare is a modern day Hydra, the mythical multi-headed creature that grew more when one was severed. It would be short-sighted not to recognize the multiple dangers that exist in the process and failing to recognize the peril will create two pitfalls for the one eliminated.
Pulling the plug on the law too quickly fails to realize that some families are caught in the web of government subsidies. Obamacare established cost-sharing subsidies to help low to middle income families that could not cover the actual costs of their premiums. Taking these subsidies away from families prematurely would result in millions of people losing access to healthcare. The GOP plan must not only have something to which these families can turn but it should provide a timeframe for an effective transition.
Despite lobbying for the law, initially, the most insurers have failed to make a profit from engagement in the Health Care exchanges. If Congress acts too hastily and discontinues the promised reinsurance payments many providers will be forced to pull out of the market leaving consumers with extremely limited healthcare options. If the repeal of Obamacare is not handled thoughtfully Democrats will be able to use any Republican failures to their advantage during the next election.
Change must come but members of Congress addressing this issue must be guided by the principle of “do no harm.” This is no longer an ideological or partisan question, just a practical one. The success of the GOP effort to fix Obamacare rests not on it’s demise but on providing consumers more options, at lower prices and ensuring that more Americans have access to quality health care than ever before.
Obamacare and its architects failed to heed the sage advice for former New York Senator Daniel Patrick Moynihan who said historic laws don’t pass barely. “They pass 70-to-30,’’ he said, “or they fail.” Rather than achieve consensus for reform, the Mr. Obama and the Democratic leadership at the time rammed through health care legislation on a partisan vote. The Republican quest for reform should not fall for a similar trap.