Replacing Obamacare should have been a low bar. The health‐care law did expand coverage, but by less than most accounts would lead one to believe. Of the roughly 20 million Americans who have gained coverage under Obamacare, nearly 11 million are on Medicaid, which provides little of actual value in terms of care. This small benefit came at the expense of virtually destroying the individual insurance market. Premiums for the benchmark silver plan have roughly doubled since the law was implemented, while out‐of‐pocket costs, including deductibles, co‐payments, and co‐insurance, have skyrocketed. Consumer choice has dwindled with insurance companies pulling out of the market — roughly a third of U.S. counties and five states have just one insurer offering Obamacare plans — and provider networks shrinking. Keeping your plan and your doctor has become a laugh line. The law’s taxes and regulations have slowed America’s economic recovery, and, according to some studies, reduced its job growth.
Most importantly, Obamacare is teetering on the edge of an adverse‐selection death spiral. As premiums rise, healthier consumers are abandoning the market. Without a pool of healthy people to offset the costs of the sick people who rushed to sign up for Obamacare, a phenomenon exacerbated by the law’s requirement that insurers cover preexisting conditions, insurers are forced to raise premiums still more, beginning the cycle anew. Obamacare’s collapse seems more a question of “when” than of “if.”
Voters understand all of this. The latest NBC/WSJ poll showed that fully 95 percent of Americans want the law changed or eliminated, and more than half believe either that it needs a “major overhaul” or that it should be “totally eliminated.”
In other words, health‐care reform may be complex, as President Trump belatedly realized, but Republicans could have hardly asked for an easier target. Unfortunately, given every opportunity to hit it, they have missed.
First, rather than having a proposal ready to go on Day One of the Trump administration, they dallied, allowing Democrats to stir up protests at town halls and seize control of the media narrative. Then, they put their plan together in secret, keeping much of the Republican rank‐and‐file in the dark. While a handful of insiders designed the replacement bill, there was little or no input from groups such as the House Freedom Caucus. Rand Paul’s traveling copy machine may have been a stunt, but it effectively illustrated GOP leadership’s extreme secrecy and paranoia. It’s little wonder the plan that resulted is already facing opposition from both moderates and conservatives.
House committees are expected to start marking up the proposal in committee as early as today, meaning members will have barely had a day to read it. The coming legislative process promises to be every bit as messy as the one that brought us Obamacare in the first place.
But as poorly as Republicans are handling the politics of health‐care reform, they are doing an even worse job on policy. Rather than embracing free‐market reforms — which might have been politically challenging but would have led to lower health‐care costs, greater consumer choice, and, eventually, expanded access to care — the Republican plan is essentially an effort to split the health‐care baby in two.