Republican members of the newly sworn-in Congress wasted no time in fulfilling a long-awaited vow: initiating the repeal of Obamacare. On Jan. 3, House Speaker Paul Ryan’s office announced a Senate resolution to repeal the healthcare system otherwise known as the Affordable Care Act.
“This resolution sets the stage for repeal followed by a stable transition to a better healthcare system,” Ryan said in a press statement. “Our goal is to ensure that patients will be in control of their health care and have greater access to quality, affordable coverage. Today we begin to deliver on our promise to the American people.”
Just what that “better healthcare system” will look like, however, has yet to be announced. And whether it could actually improve affordability for the some-20 million Americans enrolled under ACA is just as unclear.
A number of advocates for the Affordable Care Act have weighed in since Ryan’s announcement, to explain just what the Republicans will be up against as they work toward formulating another healthcare plan.
In a Sunday blog post on RealClearPolitics, Robert Reich, former secretary of labor for the Bill Clinton administration and well known for his support of the Affordable Care Act, pointed out that the ACA’s fiercest critics will have to go a distance to develop a model that is “market-based.”
“Obamacare is already market based – relying on private, for profit health insurers,” Reich wrote. And that concept isn’t exactly working, he continued, because it allows the country’s largest insurance companies to have a disproportionate say in what consumers pay, “by threatening to drop out of any insurance system.”
Some providers have already dropped out of the ACA, or imposed limitations on their participation that weren’t part of the original discussions.
And then there’s the politics – the lack of consensus on just what repealing Obamacare really means. At one time, it meant stripping away all government involvement in healthcare coverage. This week, however, discussions heated up about just how devastating a repeal could be to the nation’s economy if it isn’t replaced with a sound, well-crafted healthcare program that addresses constituents’ demand for low-cost, comprehensive insurance options.
There’s also the fact that the ACA isn’t a puzzle of distinctly crafted provisions that can just be pulled apart and retooled upon preference, Reich insisted.
“[Every] part of Obamacare depends on every other part,” he wrote. “The provision that guards against insurers denying coverage to people with pre-existing conditions works because of the comprehensive nature of the ACA: Healthy people who haven’t faced that risk are the golden egg so to speak when it comes to covering the tab for a national healthcare plan. Repealing the requirement for Americans to have health insurance may sound sexy to those who oppose mandatory coverage, but it would make it much harder to ensure coverage for those who really need it, and many Republicans in Congress know that.”
The ACA is complex, say RealClearPolitics writers Alexis Simendinger and James Arkin, and took years to construct. It may not be perfect, but any constructive alternative won’t be crafted in the first 100 days of the Donald Trump administration, or likely this year, they argued on Monday.
But the real challenge the ACA’s opponents will face in the Republican-controlled Congress is securing enough votes to push a repeal through. Consensus, or lack thereof, about what should take its place and what riders should be attached could have a decisive impact on the outcome. And Ryan’s stated plan to also defund Planned Parenthood is making some Republicans nervous, knowing that such efforts are largely unpopular with voters.
That brings us to the real stumbling block: Voters may want improvements when it comes to their healthcare options, according to a recent Gallup poll, but they don’t want their protections repealed.
According to a poll published last November, 43 percent of those surveyed said they favored changes to the law, but they didn’t want it scrapped. On the other hand, 37 percent said they would like to see the ACA replaced with something else.
The message for Republicans bent on repealing the ACA, say analysts, is to tread carefully and come armed with a suitable replacement that meets consumers’ expectations before pushing to repeal the country’s first comprehensive healthcare act. And given the fact that the ACA already utilizes a market-based format that, to some degree, ensures access to healthcare coverage for the country’s citizens, that challenge may not be so easy to meet.
Image credit: Flickr/Rob Crawley