Jonathan Chait for New York Magazine had a great article on the Republican strategy to repeal ObamaCare and replace it with nothing. He argues they have no plan and no political courage to pass anything. Below are excerpts:
The Republican Party has used health care to its advantage for the last seven years by following the same strategy: advocating an alternative plan that does not and cannot exist. During this entire time, President Obama has held power. This has afforded them the luxury of posturing against the status quo — and, indeed, doing everything in their power, at both the federal and the state level, to make it worse.
The closer they get to taking action, the more clear it becomes to Republicans that their own propaganda has trapped them and given them no escape. Railing against Obamacare was easy, but the responsibilities of power have taken all the fun out of denying medical care to the poor and sick.
A large number of Trump voters who get coverage through Obamacare “simply felt Trump couldn’t repeal a law that had done so much good for them,” reports Sarah Kliff, who spoke with many of them.
But any plan to replace Obamacare with something “terrific,” or even something almost as good as Obamacare, will violate conservative dogma. There’s no way around this. Despite the apparent complexity of the issue, it’s a very simple problem of resource allocation. In a free-market system, tens of millions of Americans will not be able to afford medical care because the cost of their treatment exceeds their income, either because they’re too poor, or because they’re too sick.
A Kaiser Family Foundation analysis finds that 52 million Americans under the age of 65 have preexisting conditions that would make it impossible for them to purchase health insurance in the individual market that existed before Obamacare.
Covering people who can’t afford to pay for their own medical care means making other people pay for it. You can do that through direct tax-and-spend transfers, or through indirect regulatory methods (like making insurance companies overcharge healthy people and undercharge sick ones). Republicans oppose these methods because they oppose redistribution in general.
And yet politics requires them to promise a plan that does not deprive Americans of access to treatment. This is the reason none of their plans has advanced beyond the white-paper concept phase —either they contain too much redistribution to be acceptable to the GOP, or too little coverage to be acceptable to the public, or both.
Republican health-care plans go much, much farther in this direction. They offer threadbare, catastrophic coverage with enormous deductibles.
Congressional staffers tell Philip Klein, a staunch Obamacare critic, that they plan to repeal the law quickly, and then replace it not all at once but with a series of “legislative changes that could be enacted in a series of shorter bills … for instance, one bill could theoretically be passed to address individuals with preexisting conditions.” This plan is so laughably hopeless it’s difficult to believe Republicans would attempt it. It’s impossible to gauge the impact of one change to the health-care system without knowing what other changes will be enacted. None of the stakeholders in the health-care system is going to support any discrete changes that could dramatically alter their business models without knowing what other changes may or may not follow.
Preexisting conditions are an obvious example of this problem. If insurers will be required to provide below-cost plans to people with expensive medical needs, they need to know what other measures will be put in place to compensate them: Subsidies? Regulations on healthy customers? Hospitals need to know how many uninsured patients they should expect to show up in their emergency rooms. In particular, popular parts of health-care reform (like benefits people get) need to be attached to unpopular parts (like ways to pay for it).
If Republicans blow up Obamacare, “the media and the left will blame the repeal vote for any turmoil in insurance markets,” editorializes The Wall Street Journal, “Republicans will own health care, like it or not.”
John Goodman, a conservative health-care-policy activist, concedes, “It’s not going to be politically possible to throw 20 million people out on the street without health insurance.”
Repeal-and-delay is the ultimate backhand acknowledgement that the party has no answers.
If Republicans repeal Obamacare without creating a replacement, insurers will have little reason to stay in the marketplace. They’ll start canceling plans immediately, and the news will be filled with stories of Americans being thrown off their medication and, in some very real cases, dying.
Repeal-and-delay will actually require taking additional action to prevent a meltdown. Insurers have begun negotiating behind-the-scenes with Republicans in Congress for concessions that would allow them to continue to cover their existing customers.
Hospitals are also warning Republicans that blowing the system up without a replacement would expose them to massive financial risk.
The most likely answer is that Republicans never craft a replacement. They repeal Obamacare, but delay the effective date of the repeal, and then Obamacare becomes a “cliff” that Congress votes to keep extending.
There is no majority in Congress behind any one specific plan to replace Obamacare, but there is probably a majority against blowing it up immediately.
If Republicans truly believed Obamacare creates more victims than beneficiaries, they would blow it up immediately. And if they really had an alternative that was more popular, they would wait to write it before they eliminated it. Repeal-and-delay proves that neither one of these is true. They have no better plan. All they can do is promise some better plan lies over a horizon that will never arrive.