Republican Senate and House leaders who have summarily decided on a “repeal and dawdle” plan for Obamacare don’t seem to understand what they are up against. They see House and Senate majorities, an incoming president who vowed to repeal all of Obamacare and a reconciliation process that allows them to gut Obamacare taxes and subsidies, essentially killing the program with 51 votes in the Senate. Do they understand it won’t be that easy?
The first problem is Republicans in the House and Senate. Several Republicans have already voiced doubts about repealing Obamacare with no ready replacement. Every freshman congressman from an unsafe district should be voicing his or her concern. Repeal Obamacare and then go back to the voters in 2018 with nothing?! Yeah, it’s risky for those new lawmakers who promised something better than Obamacare, not making health-care coverage disappear.
Next are the voters, including the Rust Belt working-class whites, a group that surely benefited from the marketplace subsidies, as reports like this one from the Atlantic magazine point out:
“Among those whose incomes are less than 200 percent of the federal poverty level-just around $49,000 for a family of four this year-whites actually gained insurance at relatively high rates. Data from the 2016 and 2014 Current Population Survey Annual Social and Economic Supplement shows that the proportion of uninsured low-income white people dropped by 8.6 percentage points from 2013 to 2015, a reduction that was roughly similar to the decrease among Hispanic people, but which outpaced the national average of 8.1 percentage points, and dwarfed the decrease among black people in the same income groups. Members of the white working class, in other words, were particularly likely to gain coverage from Obamacare.”
When members of Trump’s base start writing letters, sharing hardship stories with local media and appearing at Trump events, Trump may very well call off the “repeal and delay” strategy. Republicans who think he is locked into their strategy haven’t been paying attention. Trump doesn’t want to be seen as unsympathetic. (He won’t “let people die in the streets,” he famously declared.) It took him only one meeting with President Obama to concede that two parts of Obamacare (coverage for those with pre-existing conditions and allowing adult children up to 26 years old to stay on their parents’ plan) had to stay. With only 25 percent of the electorate approving of Obamacare repeal, he could very well turn on a dime, leaving the Republicans in Congress blowing in the wind.
And then there are the hordes of sympathetic interest groups who are about to descend on Washington. In 2017, you may hear quite a lot from the Alliance for Healthcare Security. Liberals did their legwork and organized a mammoth coalition to defend Obamacare, which already includes “1199 SEIU United Healthcare Workers East, Alliance for Retired Americans, American Medical Student Association, American Medical Women’s Association, Center for Medicare Advocacy, Inc., Community Catalyst, Doctors for America, Families USA, Medicare Rights Center, National Medical Association, National Partnership for Women and Families, National Physicians Alliance, Network for Patient Advocacy, Physicians for a National Health Program, Physicians for Social Responsibility, Service Employees International Union, National Committee to Preserve Social Security, and the United Spinal Association.”
Americans by and large like their doctors, and when doctors start warning of a health-care crisis, many lawmakers will buckle at the knees. (The American Medical Association has already warned that it will oppose any plan that takes away coverage, which presumably would nix a plan that offers access but not actual coverage.)
We have already seen hospital organizations leap into the fray. The Hill reports:
“A powerful coalition of hospitals is previewing a fierce attack against GOP leaders if lawmakers follow through on their promise to repeal ObamaCare next year. The American Hospital Association and the Federation of American Hospitals . . . fired off a damning new report warning that its industry stood to take a massive financial hit under the repeal of ObamaCare.
“The 41-page report, which was conducted by the firm Dobson DaVanzo & Associates, showed the hospital industry would lose $165.8 billion through cuts to Medicaid alone. It’s the most high-profile study yet by a healthcare industry that’s fearful of an abrupt ObamaCare repeal after the surprise victory of President-elect Donald Trump last month.”
And finally, repeal without an immediate replacement will likely spook insurance companies, many of whom have fled from the exchanges. To prevent them from leaving the marketplace exchanges altogether, Congress may have to “subsidize” them via the risk corridors or alter the requirement that at least 80 percent of revenue goes to paying claims. That is going to be intensely unpopular.
Republicans may very well jam through a repeal of Obamacare with no alternative plan in sight. They may be surprised, however, at the resistance they encounter and the magnitude of the opposition. Rather than be an “easy” win early in the new president’s term, it may turn into a knock-down-drag-out fight, or even a punt to delay action. What sounds good in a campaign ad or a white paper often becomes much more problematic when facing the consequences of such a monumental about-face in health-care policy.