Now in control of both houses of Congress and the presidency, Republicans are pushing hard to repeal Obamacare—and debating their replacement plan.
Replacement options range from Sen. Paul Ryan's 'Better Way for Healthcare' to Sen. Orrin Hatch's 'Patient CARE Act' to Sen. Ted Cruz's suggestion of effectively no replacement at all. These plans vary in means, but economic analyses suggest they all would reduce the number of Americans with health insurance, some around 3 million (Better Way), others up to 22 million (no replacement.) Proponents argue this loss would be outweighed by benefits to the system as a whole or by individual liberty to choose whether to buy healthcare more freely.
More immediately, Congressional Republicans are suggesting a "repeal and delay" plan. This would mean getting rid of Obamacare now, with a delayed effect of 2-4 years, and ideally agreeing on a replacement before that deadline.
Why is it important?
No matter what the replacement, repealing Obamacare would have an enormous effect on the lives of individual Americans and on the health insurance market.
Too often left out of this debate is a description of what Obamacare actually entails. This part is important. "Obamacare" is the unofficial name for The Patient Protection and Affordable Care Act (PPACA, or just ACA), which was signed by President Obama in 2010. These are the most significant elements of the law:
- Certain benefits, rights and protections for all Americans. For example, Obamacare ensures you have no annual or lifetime limits on healthcare, you cannot be charged more based on your gender, you cannot be denied health coverage based on a preexisting condition, you can remain on your parents' health insurance until you are 26, and more.
- An expansion of Medicaid. The law expanded coverage to everyone making less than 138% of the Federal Poverty Level ($24,300 for a family of 4 in 2017. 138% is $33,534.) However, a Supreme Court ruling now allows states to opt out of this part of the law.
- An expansion of employer health insurance. For small businesses (fewer than 26 employees), Obamacare offers tax breaks for providing health benefits. For larger businesses (more than 50 employees), Obamacare requires health coverage for full-time workers or a penalty fee.
- An individual mandate. To ensure that healthy Americans also sign up for health insurance (and therefore balance the people with preexisting conditions that insurance companies are now required to take), Obamacare requires most people to buy health insurance, apply for an exemption, or pay a penalty.
- A health insurance marketplace. Obamacare set up a marketplace in which Americans can buy regulated health insurance, apply for subsidies, or switch plans.
Should we "repeal and delay" Obamacare (remove the law with a deadline to enact a replacement)?
Simply put, 'repeal and delay' makes no sense.
If Republicans were saying, "Obamacare is so bad we would be better off with the healthcare system we had before," a repeal plan with immediate effect would be logical from that perspective.
But they're not. Instead, they are saying, "Let's repeal Obamacare but not have it go into effect for a while, because immediate change would harm people's access to affordable healthcare."
Then why not put forth a better option now, so legislators and the American public can choose between the two?
'Repeal and delay' betrays a deep-seated pessimism among Republicans that they can actually come up with an alternative to Obamacare that passes on it's own merit. The plan creates bomb in Congress and a threat: "we've repealed Obamacare and the clock is ticking, so pass this new replacement or millions of Americans will soon face the consequences."
The plan also ignores the realities of a healthcare market. If given notice that Obamacare will shut down in two years, insurers (who were already difficult to coax into many rural areas) will abandon the exchanges, leading unaffordable premiums and ravaged provider networks. It would damage people's ability to get the healthcare they need—and currently have.
It is deceptive, cowardly, and downright irresponsible with the lives and livelihoods of the American people.
Repeal and delay is the only way, given the current political environment, to ensure that in 5 years Americans are much better served by their healthcare system than they are now under Obamacare.
In 2016, many Americans voted for their members of Congress on the premise that these representatives would fix the failing system that is Obamacare. They knew that system isn't working, and not because Republicans have turned people against it. Insurance companies are reporting enormous losses and pulling out of the exchanges. Because of high premiums and more limited provider networks, people aren't buying—only about 40% of the eligible population has signed up, though insurance industry shorthand is that "75% of the eligible must sign-up to get the enough healthy people in the pool to pay for the sick."
Repeal and delay is based on two principles. 1) Agreeing on a new system for American health insurance takes time. And it should be allowed to—Americans' ability to access affordable healthcare is at stake. But 2) Americans deserve to see their votes answered, their needs met, and their representatives taking action immediately.
By voting to repeal Obamacare, delaying the enactment of that repeal, and therefore establishing a deadline to come up with a replacement, representatives will be telling the Americans that voted for them, "we heard you." And they will begin the hard but necessary work of finding a new solution.
- President Obama's interview on the subject this week with Vox
- "If it works, I'm for it... I am saying to every Republican right now: “If you can in fact put a plan together that is demonstrably better than what Obamacare is doing, I will publicly support repealing Obamacare and replacing it with your plan. But I want to see it first. I want to see it first."
- Sen. Paul Ryan's plan, "Better Way"
- "Obamacare has limited choices for patients, driven up costs for consumers, and buried employers and health care providers under thousands of new regulations. It forced people into expensive plans they did not want and put the government in charge of one of the most personal decisions families will ever make. House Republicans know there is a better way."
- Sen. Oren Hatch's plan, The Patient CARE Act
- "Our nation’s health care system was broken before Obamacare, and the President’s health care debacle has only made things worse. The Patient CARE Act repeals Obamacare and addresses the fundamental cost drivers that Obamacare failed to address."