Is Trump Trying To 'Make America Sick Again'?

Repealing Obamacare now would absolutely have huge real-world effects.
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Republicans want to repeal Obamacare. That much we know, and we’ve known it ever since Obamacare was first signed into law.

The Affordable Care Act known as Obamacare expanded health insurance coverage to more than 20 million Americans who had previously been uninsured. A full repeal of the law could leave those people uninsured again. Vice President-elect Mike Pence renewed the pledge to repeal Obamacare during a visit to Capitol Hill on Wednesday, saying, “The first order of business is to repeal and replace Obamacare, and that was our message today, and it will be our message on Capitol Hill. It needs to be done.”

As a medical professional and Democrat, repealing Obamacare now would absolutely have huge real-world effects. It would mean taking insurance coverage away from millions of people—unless, that is, Republicans can coalesce around a replacement that will cover all those people, or at least get in the same ballpark. Many hospital groups and physicians have gone on the record warning that passing a repeal bill without a replacement could be massively disruptive, even if the repeal is delayed. Also, this week alone, leading physician groups, including the American Medical Association, joined the push to slow the repeal campaign. Others urging caution include the American Diabetes Association and the advocacy arm of the American Cancer Society.

California Democratic House Minority Leader Nancy Pelosi has also blasted Republicans for their apparent repeal and delay approach.

“Repeal and delay is an act of cowardice on the part of the Republicans,” Pelosi said earlier this week. “Where are they going to get the votes to replace? If, in fact, ideologically they’re opposed to a public role and any participation in the good health of the American people, where are they going to get the votes, unless they were to act in a bipartisan way?”

Republicans, though, are far less unified around what a replacement ought to look like than they are in their opposition to Obamacare. After much research on my end (and putting my master’s degree in public health to work), there are a couple of ways of going forward that I deduced:

Option #1:

GOP legislators simply suck it up and do the hard work of passing piecemeal health reform legislation, with the help of Senate Democrats. The smartest approach would be to give up on starting from scratch and instead give people who can’t or won’t buy Obamacare-compliant insurance plans the option of buying cheaper, less-comprehensive insurance without premium subsidies. Subsidized Obamacare-compliant plans would still be available on the exchanges, which would serve as a safety net for those too sick or too poor to afford bare-bones plans with high out-of-pocket costs. Instead of pulling the rug out from under states that expanded Medicaid under Obamacare, Congress could pick up a higher share of the tab for the poorest and sickest Medicaid beneficiaries while asking states to take on more responsibility for helping the healthiest of them, a swap that would greatly relieve the pressure on state budgets. So basically, rather than completely dismantling Obamacare, Republican lawmakers could act as sculptors, chipping away at the provisions they like least.

Option #2:

Repeal Obamacare without a plan for replacing it and watch America’s health insurance market erupt in flames. Yeah, I’d go with option #1.

Sadly, Senate Majority Leader Mitch McConnell appears adamant on option #2, again a strategy for unraveling Obamacare in the messiest, most chaotic way possible.

The good news is that a handful of Senate Republicans get that repeal and delay would be an epic disaster for the GOP, so they’re pushing back against McConnell. Maine Senator Susan Collins has come out against it, which is not shocking considering she represents a Democratic-leaning state. More surprising is the opposition of Kentucky Senator Rand Paul, who has said he’s opposed to repeal and delay because it adds too much to the federal budget deficit. Louisiana Senator Bill Cassidy, who has a reputation of being heavily involved in health care policy, has also expressed skepticism about repealing Obamacare without having a replacement ready to go. And as of Thursday night, Arkansas Senator Tom Cotton, an advocate among younger conservatives, has joined the rebels.

Much of the law could be legally repealed by mid-February or so, but with a deferred roll-up date of perhaps two or three years. And there’s little GOP consensus about an alternative. President-elect Trump left what’s now called “TrumpCare” open to negotiation and, well, interpretation (“something terrific”) he quoted. Stay tuned.