When Obamacare passed in 2010, it marked a turning point in American politics from which we will almost certainly never recover. For fans, this was a good thing. For foes, necessarily bad. But a few permanent truths emerged that our current discourse must acknowledge.
@MelissaTweets 4. Every election afterward would be about reforming health care.
— Matthew DesOrmeaux ⚜ (@authoridad) March 7, 2017
We’re stuck with it now, and the main purpose of our politics will be to reform it every 4 years. That’s the point of any government-driven health care - having your own team control it.
And in that vein House Republicans have introduced their own version of health care reform reform - the American Health Care Act. President Trump has endorsed it, and HHS Secretary Price, who would implement it if passed, has called it a good first step in the process.
But the first step in the process was supposed to be repealing Obamacare itself in full. That’s what almost every Republican has campaigned on since the Tea Party wave in 2010. The AHCA doesn’t repeal the ACA in full, and in fact doubles down on much of it, just in a Republican way instead of a Democratic way.
Medicaid expansion would be phased out over several years, but only by attrition, not by execution, and states could still opt into it in the meantime. Even the way the bill block grants Medicaid back to the states encourages more enrollment, not less.
While AHCA does end the individual mandate, it replaces it with a new ability for insurers to charge more for people whose coverage has lapsed a certain amount of time. They’ve taken away a power from the government and given it to corporations. This is not an improvement, and it’s not an expansion of freedom or choice for consumers. Fortunately the plan does repeal a slew of other taxes enacted by Obamacare.
Similarly the GOP plan ends federal subsidies that make state exchange plans cheaper, but replaces them with tax credits for individuals without employer-provided coverage. Again, not really an improvement, just a recharacterization.
These failures and more have led conservative groups to dub the proposal Obamacare Lite and RINOcare, well-deserved epithets for this unfortunate half-measure.
The proposal that Rand Paul introduced in the Senate in January is a much more worthwhile political investment that would actually repeal the bulk of Obamacare and replace it with free market, state-based solutions.
Unfortunately, the longer this goes on, the more unlikely any repeal and replacement becomes. Since the law was first passed in 2010, public opinion of Obamacare has been significantly against it. On election day last year, 48.7% of voters opposed it. Immediately following the election, that began to change. In mid-January support surpassed opposition for the first time ever, and it now sits at 48.5% approval.
Americans are not fond of giving up entitlements that have been bestowed upon them, and Republicans are going to have to come up with a grand slam to make it happen this time. AHCA isn’t it.