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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Political Strategy Notes – Obamacare Repeal Edition

NYT’s Robert Pear reports on the latest GOP schemes to repeal Obamacare, or at least the latest timetable, beginning this week: “Within hours of the new Congress convening on Tuesday, the House plans to adopt a package of rules to clear the way for repealing the health care law and replacing it with as-yet-unspecified measures meant to help people obtain insurance coverage…Then, in the week of Jan. 9, according to a likely timetable sketched out by Representative Greg Walden, Republican of Oregon, the House will vote on a budget blueprint, which is expected to call for the repeal of the Affordable Care Act…Later, in the week starting Jan. 30, said Mr. Walden, incoming chairman of the House Energy and Commerce Committee, the panel will act on legislation to carry out what is in the blueprint. That bill would be the vehicle for repealing major provisions of the health care law, including the expansion of Medicaid.” No one seems to know just what the particulars will be, but Pear also notes, “The law also saves hundreds of billions of dollars by reducing the growth of Medicare payments to hospitals, nursing homes, health maintenance organizations and other health care providers. Repealing the law would eliminate those savings and thus increase federal spending, the Congressional Budget Office says.”

The Guardian explains various Obamacare repeal scenarios with “How Obamacare could be dismantled by Republicans” by Jessica Glenza and Nadja Popovich. The authors provide a “how it works/how it could go” analysis (with some polling data) concerning 11 key provisions of the Affordable Care Act, including: the individual and employer mandates; pre-existing conditions; the Medicare payroll tax; insurance exchanges; health plan subsidies; Medicaid Expansion; Donut Hole and 39 rule; free preventative seervices; converage for young adults; and the ban on coverage limits. There is not much here that supporters of strengthening Obamacare will find encouraging.

What seems likely as not when all of the dust settles, is that the Republicans will make a big flashy show of repealing Obamacare, keep much of it, but call it something else, screw around with funding mechanisms and leave a hideous mess for government accountants, the health care industry and millions of Americans with weakened health security to sort out, and then loudly proclaim a great victory. In her preview of the upcoming week’s repealapalooza festivities, HuffPo’s congressional reporter Laura Barron-Lopez writes “The GOP’s current plan is to move swiftly on repeal legislation and then spend up to four years developing a consensus on a new set of health care reforms ― an achievement that has otherwise eluded the party for years. But Republicans are already split over how long they’ll spend creating that replacement. Party leaders expect it to take years, but some conservatives are pushing for a replacement to be finished within one year…Democratic leaders have been defiant about Republicans’ chances of pulling off this effort. House Minority Leader Nancy Pelosi (D-Calif.) predicted that Republicans would not repeal Obamacare once they realized how difficult it would be to replace…“They’re not going to repeal it,” Pelosi said earlier this month. “I don’t think they’re going to repeal the Affordable Care Act.”

At New York Magazine Ed Kilgore explains “The Latest ‘Repeal and Delay’ Idea for Obamacare: Grandfathering!,” noting that “Now comes the American Enterprise Institute’s conservative health wonk James Capretta with an idea that cuts to the chase: Why not just “grandfather” all the people currently receiving benefits via the ACA and make whatever the new “replacement” system turns out to be prospective for new people seeking assistance?” Kilgore acknowledges that “the idea has the advantage of being relatively simple and predictable,” but adds “Until the GOP can pass something that garners bipartisan support and solves the Obamacare problems it has identified, it should do nothing. That’s the ultimate “grandfathering” — leave the system in place. That is the only real solution politically or policy-wise that doesn’t create a raft of victims. The sooner the GOP figures this out, the better.”

Sean Williams reports at Fox Business, no less, that “In an Ironic Twist, Obamacare Enrollment Hits an All-Time High.” Williams writes, “Yet in spite of its perceived demise, Obamacare enrollment is currently proceeding at a record pace, at least according to the Department of Health and Human Services. According to the HHS, roughly 6.4 million people had enrolled via HealthCare.gov, the federally run website that runs the online marketplace exchange for more than three dozen states, between Nov. 1 and Dec. 19. This represents an increase of nearly 7% year over year, or about 400,000 enrollees…The data midway through 2016 from the Centers for Disease Control and Prevention found that the uninsured rate had fallen to 8.9% from 16% in the quarter immediately preceding Obamacare’s implementation on the individual market. If the early enrollment data is any indication, the uninsured rate could fall even further in 2017.”

Vox will be running an live-streamed interview with President Obama on Friday, January 6th on the topic of Obamacare repeal prospects, with an audience of Obamacare enrollees who are also members of the Vox Facebook community. Meanwhile Sarah Kliff and Ezra Klein write at Vox that “the Affordable Care Act’s marketplaces have struggled to attract health insurers who want to sell coverage” and “about half of Obamacare enrollees say that they’re unsatisfied with the high costs of premiums and deductibles… That’s what we want to talk to the president about: the lessons he has learned from six years of implementing the biggest health coverage expansion in decades, his thoughts on its political vulnerability now, and the challenges Republicans may confront as they embark on a similar task.” Kliff and Klein note that “Economists, however, are skeptical that Republican plans will cover as many people as Obamacare currently does. Estimates predict that the plans the GOP has offered so far will lead to anywhere from 3 to 21 million Americans losing health coverage, depending on which plan Republicans pick.”

At Forbes, Duke University/American Enterprise Institute scholar Chris Conover mulls over “How The Patient CARE Act Would Repeal And Replace Obamacare” and observes that “this plan would result in very modest reductions in coverage, accompanied by massive federal tax savings (to the tune of more than one half trillion over ten years!).” I’m guessing that Conover’s health security will not be adversely affected by the “modest reductions in coverage” he envisions for others.

However, at Vox Sarah Kliff explains some of the effects of The Patient CARE Act in less than glowing terms: “There are two economic analyses of CARE Act available at this point. One, from the RAND Corporation, estimates that it would cause 9 million Americans to lose coverage by 2026. Another, from Parente’s Center for Health Economy, estimates that 4 million would lose insurance the same year… In addition, the Patient Care Act suffers from the same major flaw as all of the republican proposals,” making insurance cheaper for young people and more expensive for old people.” Further, “Eibner has done economic modeling of the CARE Act (although not Better Way yet) and is able to show who benefits and who loses under the proposal…She finds that under the CARE Act, only 85 percent of 21-year-olds would see their premiums either stay the same or decline compared with Obamacare. But 100 percent of 50- and 60-year-old enrollees would see their premiums increase under CARE Act.” Thus many seniors who are surviving on Social Security can expect a health care premium hike under this plan.

What is so frustratingly childish about all of the Republican Obamacare repeal talk, is that they all know that none of the health care reforms they now claim to support would ever have gotten a fair hearing, much less enacted, without Obamacare. The GOP has always been content to let health insurers and ritzy physician groups gouge and impoverish consumers who face major illnesses. With the exception the Medicare prescription drug benefit Bush II signed, the Republican Party has never provided leadership for broadening health care security for Americans. Instead they have resisted significant reforms, from Medicare and Medicaid on down to the Affordable Care Act. When you take a look at the most recent polling on Obamacare, you find more respondents saying they “disapprove” than “approve” of the ACA. But when the question is framed in terms of should it be repealed or expanded, the most recent Pew Research poll, conducted Oct. 20-25, found that 53 percent of respondents say “expand it” or “leave it as it is.” No matter what happens to Obamacare, President Obama can always be proud that his leadership has saved countless lives and improved the health securitry of millions of Americans. Thanks to him, the Republicans can no longer hide from public demand for affordable health care.

One comment on “Political Strategy Notes – Obamacare Repeal Edition

  1. Dan on

    Will this actually cause anyone who voted R and has health insurance because of Obama Care legislation to vote D in the future?
    Probably not.


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