Although it was not mentioned in a video detailing his priorities as president, Donald Trump remains eager to repeal and replace the Affordable Care Act. So says Vice President-elect Mike Pence, who spent the weekend assuring Trump supporters that the health care law colloquially known as Obamacare remains near the top of the president-elect’s to-do list.
But as Republicans prepare to take control in Washington, D.C., they might find that governing is more difficult than delivering rhetoric. Since the election, Trump and House Speaker Paul Ryan have said they would prefer to retain two primary provisions of Obamacare: protection for those who have pre-existing conditions; and assurance that young adults can remain on their parents’ insurance plans.
Add in the fact that scuttling Obamacare would eliminate insurance for millions of people, and the incoming administration is faced with a political conundrum. The difficulty is that protecting those with pre-existing conditions but eliminating a mandate that everybody must purchase coverage (or face a tax penalty) would deprive the system of millions of healthy people. That would leave only the more costly clients who are more likely to become ill, driving up premiums and threatening the system.
Despite all of their anti-Obamacare rhetoric in recent years, Republicans will be hard-pressed to find a cost-effective solution. The situation calls to mind when Rep. Cathy McMorris Rodgers, R-Spokane, invited followers of her Facebook page to share their Obamacare horror stories and she got the opposite — tens of thousands of tales about how the law had saved lives and had allowed many to finally receive coverage.
Undoubtedly, Obamacare can use some improvement. In many states, the cost of premiums has risen sharply and insurers have withdrawn from the state exchanges. But some provisions, such as coverage for pre-existing conditions and insurance for young adults, are wildly popular. At least Donald Trump and Paul Ryan think so.
Writing for The Washington Post, Steven Pearlstein, a professor at George Mason University, points to a plan that would “eliminate the tax-free treatment of employer-paid health insurance and use the $260 billion in increased revenue to give tax credits for every American to offset the cost of buying health insurance.” This was recommended by Republican presidential candidate John McCain in 2008 and has support from some Republican senators. Pearlstein also suggests that a well-designed replacement to Obamacare could make it possible for all Americans to afford health insurance without resorting to a mandate, which is unpopular with conservatives.
Other thoughtful plans also have been floated, which is more than can be said about Republican efforts to repeal but not replace the Affordable Care Act over the past six years.
The difficulty now can be found in the difference between governing and complaining. It also can be found in the difference between demagoguery and compromise. Democrats failed to serve the American public in 2010, when they pushed through a health care overhaul with nary a Republican vote while insisting, “We have to pass the bill so you can find out what’s in it.” Republicans have shirked their duties in decrying Obamacare while ignoring its benefits and refusing to offer an alternative.
Many people have wistfully spoken about the need for the nation to come together in the wake of the election. Finding a way to improve health care would be a good place for Congress to start.
