When House Republicans passed a budget resolution in the fall of 2013 they tried to do what the Supreme Court did not a year earlier: block the Affordable Care Act before its unwelcome provisions, like the individual mandate, could be rolled out. That attempt to defund President Obama’s health care overhaul stalled when Senate Democrats called the GOP’s bluff; their insurrection fell apart after 16 days, but it left behind plenty of ugly images and odd anecdotes that have come rushing back now that the drive to dismantle “Obamacare” is ramping up again.
The road this leviathan traveled since its inception has been rocky and at times advocates and opponents have been theatrical in their efforts, like when House Republicans staged dozens of symbolic votes in a long-running attempt to delay, defund, or repeal the measure. Early on the crusade to keep Obamacare from crossing a legal Rubicon made sense given my pre-existing wariness of any big, new entitlement; I still consider any coverage mandate a violation of the Constitution’s Contract Clause that is distinct from a similar requirement to buy car insurance, but the Supreme Court disagreed.
The health care law had faults that went beyond court decisions and a sloppy rollout of the healthcare.gov website. The Affordable Care Act set a baseline of ten “essential health benefits” that range from prescription drugs and rehabilitation to maternity and pediatric services — every policy sold on the exchanges had to meet all ten. The individual mandate was included to drag a legion of new consumers into the insurance market who would pay for these “essential benefits.” That pool of younger, healthier customers did not buy in; the two years since have seen premiums increase, while enrollment has fallen short of expectations, and critics believe a conspiracy is afoot.
The reality confronting this freshly-minted GOP unity government is a bit less dramatic: the Affordable Care Act relied on a precariously balanced system of financial gears worthy of Rube Goldberg. It’s been further hobbled by a poorly designed method of collecting what has been a relatively cheap ‘tax’ and the neglect of a coveted demographic known as “young invincibles.” The problem confronting Republicans now that they are on the verge of vanquishing the Obamacare dragon is what happens on the day after. The Tea Party and talk radio-listening base will be thrilled, but if Donald Trump and Paul Ryan break the existing system the failure will be theirs.
Once the 115th Congress was sworn in and confronted by that reality they turned away from a repeal-and-delay strategy GOP Senator Bob Corker described as problematic and unappealing. The Congessional Budget Office contributed to what is already a tense environment when it issued a report last week which forecast a 20% jump in premiums and 18 million new uninsured Americans by next summer. The CBO analysis is flawed in one important way — it is an incomplete update of a similar review completed in 2015 that cannot account for the unknown combination of regulatory changes, executive orders, and new legislation that will likely replace Obamacare.
A simple ceremony on inauguration day was the first sign this dam is breaking; the new president went to the White House and signed a one page order aimed at minimizing the health care law’s “unwarranted economic and regulatory burdens.” What happens next is anyone’s guess, but the future will likely hinge on Trump’s ever-changing whims. Republicans in Congress have to be torn: the one-time developer is talking up an “insurance for everybody” scheme, one that would compete against a similar effort headed by House Speaker Paul Ryan that will likely emphasize insurance access, risk pools, and tax credits over coverage. Expect a bruising battle once the GOP settles on its plan and runs into the wall Democrats are building in the Senate.
photo courtesy of cdn.bipartisanreport.com