Monday, November 21, 2016

Big Surprise: Repealing Obamacare is hard

On more than 60 occasions House Republicans voted to repeal the ACA, so called 'Obamacare' and with the Senate even defunded it once.   These were free votes because the House knew the Senate would save them and the Senate knew the President would veto defunding.

And even today nearly every Republican in front of a mic is promising the will repeal 'Obamacare' right away.  Republicans are great revolutionaries, but they are completely incompetent on crafting policy.  And they are starting to figure this out.

Think about the people with Obamacare insurance who have cancer and need chemotherapy. Think of the patients with brain tumors who need an MRI scan. Think of all the patients at risk of heart attacks and strokes who need surgery.  Think about all the children in their early 20s kicked on their parents plans.  Think about the reaction when you give these people exactly what you promised them and then imagine watching this play out nightly on TV.

As recently as last Sunday Trump told Lesley Stahl on 60 Minutes that there would be no repeal without replacement. And there will be no gap between repeal and replacement – not even a single day.

And here is the problem Republicans face: 'Obamacare' is the Republican healthcare plan.  Liberals favor single payer.  What Republicans now call  'Obamacare' was conceived at the Heritage Foundation and first implemented by Mitt Romney as governor of Massachusetts.  It's market based provided private company insurance with subsides through an online exchange, or market, if you prefer.

In the nearly 7 years since the passage of the ACA, Republicans have never been able to agree on how to replace it.  The proposal begins by abolishing Obamacare and all its revenues. Then to avoid throwing 20 million people out on the street it imposes a Republican Cadillac tax, which is basically a tax on the health plans of ordinary workers. This tax will have to be very large in order to fund insurance for 20 million people. It would have to be really, really large to achieve the Trump goal of universal coverage.  Except every Republican in the House is on record as opposing a Cadillac tax. And even if they weren’t so inclined, Trump has promised to lower taxes on blue collar workers, not raise them.  Perhaps the largest failing of Obamacare, which Trump has promised to fix is that even now something like 30 million Americans remain uninsured, and unless we make fundamental changes ot our approach to healthcare, this number isn't likely to move much.

"I've got to see replace" said Sen. Claire McCaskill, (D MO), in an interview with Talking Points Memo.. "I've threatened to bring bloodhounds to the Capitol to find replace. For years, I've been looking for replace. I've looked in committee rooms, I've looked in hearing rooms, I've looked under desks, I've looked in closets. There has never been a replace."  "Let's see how that would work for the millions of people who have certainty and security right now."

I expect we will see a proposal for universal healthcare by tax credit, but that is going to be enormously expensive with no revenue streams to subsidize the credit.  And what about preexisting conditions and all the other reforms to non-employer sponsored healthcare that the ACA brought us that everyone now takes for granted?

Shooting your mouth off is easy when you never expect to be called upon to deliver.  Now, Republicans have to deliver and I don't think they're cut out for it.

As the Zen Master says, 'We'll see'. 

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