When The Affordable Care Act (ACA) was enacted, Republicans said it would be Barack Obama’s “Waterloo.” In his first Presidential campaign Donald Trump promised to quickly “repeal and replace” it, which congressional Republicans have unsuccessfully tried four score times.
This week Obamacare will haunt Republicans again as they block a Senate vote to extend the enhanced health care subsidies that expire at the end of this month. Without this extension premiums are expected to rise, on average, by more than $1,000.
Rather than Waterloo, after several years of uncertainty the public has warmed to Obamacare. Neither congressional Republicans nor Trump, for all his bluster, has ever offered a real replacement. Legislators who’ve discussed it with this President say he has little knowledge or much interest in the substance. Unlike taxes or regulation or entitlements the GOP has a shortage of genuine health care experts.
“Republican politicians want less government spending and less regulation,” notes Larry Levitt of KFF, the top health care research firm. “The tradeoff is worse affordability for most people.”
As the ACA becomes more popular and ingrained the Republican take and plans are out of step with voters, including some Trump supporters.
To be sure, the ACA has its shortcomings, some of them stemming back to the start when there was no House-Senate conference to reconcile some problems and contradictions, as the Democrats had just lost their filibuster-proof majority in the Senate.
Premiums are too high, choice is too limited and corruption hasn’t been eliminated.
But most voters now correctly see this as better both than what was and any changes proposed by Republicans.
The percentage of Americans without health insurance has been cut in half to around 8% from fifteen years ago when Obamacare was enacted. Many millions now with pre-existing conditions receive care which wasn’t available before Obamacare.
Republicans have an irrational hatred of Obamacare and were ecstatic over its rough start. It hasn’t lessened as the attitudes changed. Eight years ago Republicans were enraged when the late Sen. John McCain famously voted with a thumbs down to kill a repeal.
This was an eminently responsible vote. Republicans, egged on by Trump, sought to dismantle Obamacare but lacked a serious plan to replace it; their “Skinny” bill, as it was labeled, was a farce.
There is a division within Republican ranks which makes the decidedly uphill task virtually impossible. Some Republicans, more moderate or in a more competitive district, want to tweak the ACA by trimming costs and instituting a few reforms; those ranks probably include Trump whose antagonism is driven by his disdain for Obama.
Most right wingers, however, simply want to kill Obamacare. They aren’t receptive to less sweeping changes and basically want to let the market handle it.
The deep flaw here, says Ezekiel Emanuel, an oncologist, bioethicist, a University of Pennsylvania Provost and one of the architects of Obamacare, is that health care is not a marketplace; the notion of giving consumers money and letting them shop for the best health care deals ranks somewhere between naive and ignorant.
Personally, I have a relatively simple health care situation, relying on Medicare.
But I have a child with significant disabilities and heavy health care costs. Navigating the best options is so complicated and unsettling that I tried to find a health insurance adviser like a financial adviser for investments. No luck.
Health care will be a driving force in Democrats’ success in the midterm elections next year. Republicans dealt with the issue in their “Big Beautiful Bill,” chiefly by slashing spending on Medicaid and eventually Medicare. As health care premiums soar, more voters will blame Republicans, justifiably.
This is a prime component of the affordability issue that Trump is trying to run away from.
Zeke Emanuel sees a great irony in this debate. The ACA largely was modeled after Republican initiatives, particularly what then Governor Mitt Romey did in Massachusetts and even Richard Nixon in his Presidency.
Notes Emanuel: “Obamacare is a conservative idea -- giving individuals subsidies to buy private insurance is something Republicans have been advocating since the late 1940s.”
Even out of office, Barack Obama continues to dominate Republicans on health care.
Yes Obamacare has its share of problems. Getting rid of the subsidies will make our healthcare system even worse. Personally, I’m studying how the other advanced countries run not only their healthcare but their whole form of government.
Have you tried health insurance brokers for your son?
From a political standpoint, the math isn't all that favorable for ACA advocates. Less than 10% of Americans are covered, and even though most of them are from red states, they are still far from decisive in my view.