With its furious attack on the Affordable Care Act, aka Obamacare, has the GOP become the proverbial barking dog that finally caught the bus it has chased for so long? Partisans continue to proffer notions for what might be part of Trumpcare.
But for the R’s in the House and Senate who have insisted for seven years that they would swiftly repeal and replace Obamacare, two more R’s, uncomfortably, are intruding: Reality, and the new buzzword Repair.
The Trump Administration—no surprise—hasn’t provided details. But it told the federal Office of Management and Budget that it soon will submit proposed regulations aimed at stabilizing health insurance markets during any Obamacare transition.
This step is becoming a big and needed one. Partisans promised that the ACA would be acted on, on Day One, when the GOP seized control of the presidency, Senate, and House. Their timeline since has slipped and seems open, with action perhaps not until 2018.
But major insurers are offering dire warnings that markets cannot operate in uncertainty, and they face looming legal deadlines in the spring to submit rate and other coverage details for next year. They have threatened to withdraw from Obamacare exchanges. That could, as I have written, cause an Obamacare collapse that could strip tens of millions of health insurance they depend on. This would be a giant nightmare for the GOP, which continues to hammer the ACA, including its insurance enrollment (which did dip), though no replacement is in sight.
The possibilities of health care chaos already are roiling some critical constituencies: employers, who provide coverage to their workers are expressing growing upset about potential collateral damage to their job-based plans, and the AARP, the largest organization representing tens of millions of seniors older than 50, is getting more fired up.
To tamp down public unrest, party leaders have turned to Frank Luntz, one of their messaging masters, and they’re trying to pivot to portraying themselves as aiming to “repair” the ACA. With polls showing it is more popular than ever, and becoming even more so, Obamacare fixes seem to be an idea that resonates with voters, GOP strategists say.
At the same time, to satisfy their staunch and disgruntled supporters , the Republicans, of course, must hasten to note that any tweaks would be implemented before they get around to repealing and replacing Obamacare. Reality, though, keeps pushing Trumpcare further and further off on the horizon.
Reality pushing back
If the president hoped Tom Price, his nominee to head the Health and Human Services Department, would be a key architect of a new course on health care, well, his confirmation has stalled some, partly due to: the Democratic furor over precipitous Administration actions and orders on issues like immigration; and deepening concern on the Hill about Price’s ethics, and, now his truthfulness, too.
The biggest obstacle partisans confront with Obamacare replacement — which, they finally seem to have realized must be well formed before its repeal — rests in the act’s history, ambitions, and, yes, accomplishment. It has allowed tens of millions to get health coverage they didn’t have. Though Republicans asserted throughout the previous Administration that they had a ready alternative, clearly they did not. They also have ignored that the ACA didn’t happen in a snap. It took President Obama, who unlike the current occupant of the Oval Office was a wonk with government experience and a deep concern about health care, more than a year to get it in place. It was built on President Clinton’s disastrous efforts, as well as, yes, GOP models like that of Massachusetts and its former governor Mitt Romney. It affects health care in many varied ways, and, especially seven years in, it will be mighty hard to cherry-pick which (popular) parts of it can be sustained and which will go. This is especially true with its finances, including the individual mandate.
Meantime, the GOP isn’t doing itself or Americans much of a favor by recycling hoary alternatives, including some I have written about before. It seems, for example, as if health savings accounts (HSAs) are popping back up as a favored option for some ACA opponents. These have their place. But this, frankly, is a boon for the rich who can afford to put money in them and to get tax benefits out. Most American’s struggle to cover day-to-day expenses and they lack emergency and regular savings, much less spare cash for HSAs. Further, for those who do stash cash in HSAs, it is all too easy to blow through the banked sums for care due to illness and other need for medical services, separate from setting aside that money to pay for health insurance.
In my practice, I see how people harmed while seeking medical services not only look for justice but also for the financial support and security they may require for a lifetime. Health care, including insurance, isn’t a frill or an option. In this richest country in the world, health care needs to be a right. We need to be dogged in our determination that our elected public servants in Washington do the right thing for all of us.