The Health Care Battle

The opening volleys in the shredding of the social safety net have been fired.  The 2017 Republican attack on the Affordable Care Act is officially underway.

Republicans have been threatening to repeal ACA since it was enacted.  Until now, President Obama's veto has been all that stood in the way.  On Thursday the Senate and on Friday the House adopted budget resolutions that, with simple majority votes, could repeal the Affordable Care Act without replacing it.

Democrats, notably including Senate Minority Leader Schumer, have promised to resist the Republican efforts at repeal unless there is a replacement plan in place.  "Senate Democratic sources familiar with Schumer’s thinking say he will not engage in any negotiations to pass a watered-down version of the landmark healthcare reform law if Republicans unilaterally force its repeal first under special budgetary rules." (The Hill, Jan 15)

On Saturday, president-elect Trump, who favors simultaneous repeal and replacement, entered the fray.  In an interview with the Washington Post, "President-elect Donald Trump said...that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of 'insurance for everybody,' while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid." (Washington Post, Jan 15)

The Affordable Care Act ("Obamacare") has helped at least 20 million people gain access to health care.  The uninsured rate has almost halved: dropping from 16% to 8.9%. (Bloomberg.com)

One of the most important elements of the Affordable Care Act is the Medicaid expansion.  The following graphic shows the states that would be at risk of losing this coverage.

Repeal of the ACA would have repercussions across the country:

• the number of uninsured would climb by almost 30 million by 2019 [1]
• the health care industry would lose $3 billion in premiums [1]
• the newly uninsured would seek an additional $1.1 trillion in uncompensated care between 2019 and 2028 [1]
• up to 3 million jobs in the health sector and other areas would be lost [2]
• $1.5 trillion reduction in gross state product from 2019 through 2023 [2]
• cost the Federal government $350 billion over the next decade [3]

In addition, repeal would seriously disrupt the health care market.  "The speed of Republican efforts to repeal the Affordable Care Act has stunned health industry lobbyists, leaving representatives of insurance companies, hospitals, doctors and pharmaceutical makers in disarray and struggling for a response to a legislative quick strike that would upend much of the American health care system." (Boston Globe/NYTimes News Service, Jan 10)

So, the rallying cry of the Republicans has become "repeal and replace."  Unfortunately, there is no Congressional Republican replacement plan that could pass Congress.  The Affordable Care Act took two years to craft.  To think that Republicans can come up with a suitable replacement in two weeks or even two months is ludicrous.  And that is the point of concern.  Is Republican hatred of Obamacare (and of Obama's legacy) so great that they will throw 20-30 million people off health care insurance, disrupt the market, blow a hole in the Federal budget and wreak havoc with state economies?

The Republicans have painted themselves into a corner.  For seven years, they have screamed about repeal.  It's been red meat to their base, a sure-fire vote getter.

Then, late last year, anecdotes started coming in from the hinterlands about Trump voters who were getting worried.  Concern was particularly high in coal country.  “ I voted for Trump,” Neil Yonts, who was a coal miner in Kentucky for 35 years, told CNN’s Miguel Marquez. But, he added, he felt it “may be a mistake” after being diagnosed with black lung disease and learning about the Obamacare protections, which may soon disappear. “When they eliminate the Obamacare they may just eliminate all the black lung program,” he said. “It may all be gone. Don’t matter how many years you got.”  (deathandtaxes website, Dec 26)

Now some Republican governors whose states benefit from the ACA are raising concerns.  At least "five of the...Republican governors of states that took federal money to expand Medicaid are advocating to keep it or warning GOP leaders of disastrous consequences if the law is repealed without a replacement that keeps millions of people covered."  (Politico, Jan 13)

These mounting concerns of Republicans combined with Democratic opposition to repeal and the as-yet-undisclosed Trump plan may be enough to slow the dismantling of the ACA until a replacement can be in place.  If not, if Republicans somehow successfully push through "partial repeal that keeps in place Obamacare regulations but not the spending to maintain the program,...[Republicans will create] a recipe for a long, drawn-out political catastrophe in which the individual health care marketplace slowly collapses." (Boston Globe, Jan 10)  And the lives of tens of millions will be affected.

[1]  "Implications of Partial Repeal of the ACA through Reconciliation", the Urban Institute 
[2]  CNBC, Jan 5 citing a joint study by the Commonwealth Fund and the Milliken Institute
[3] CNN, Jan 4 citing an analysis by the Committee for a Responsible Federal Budget