Since the landmark Affordable Care Act became law in 2010, congressional Republicans have vowed to repeal Obamacare. Despite more than 60 House votes and a 16-day government shutdown, Republicans failed.
But as Congress reconvenes after the holiday break, an empowered Republican Party is likely to succeed, endangering the lives of more than 20 million Americans and affecting all of us in ways we may have never imagined.
As the saying goes, be careful what you wish for. Now, with both houses of Congress and the presidency soon to be in Republican hands, the GOP will have the power to kill Obamacare. They will also own the consequences.
We first heard Republicans promise to “repeal” Obamacare. That vow morphed into “repeal and replace,” with few details given about how it would be replaced. As he campaigned for president, Donald Trump picked up the chant, going even farther by pledging to replace Obamacare with something “bigly” better.
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Beyond a recent “60 Minutes” interview, we have few clues what Trump views as “better.” He said he wants to retain two popular “mandates” requiring coverage for people regardless of their pre-existing medical conditions, and for keeping adult children on parents’ medical plans.
But just how are these expensive mandates going to be paid for without the other provisions in the far-reaching, complicated ACA?
Without suddenly throwing 20 million people to the “medical wolves,” repealing and replacing Obamacare must be the result of a thoughtful, deliberative process. It must not be done in haste or out of a demagogic desire to satisfy political promises.
Republican congressional leaders seem to understand this. Using a legislative maneuver that will allow a simple majority vote, they will try to quickly defund Obamacare, but allow it to remain in place for months, maybe years, until a replacement is passed. That’s the new “repeal and delay” approach, which is stirring up anger in the party’s base and threatening to drive insurance companies out of the market.
Recognizing the dangers of such a tactic, Tennessee Sen. Lamar Alexander, Republican chairman of the Senate Health, Education, Labor and Pension Committee, is pressing to have a replacement plan ready before Obamacare is repealed. Although this is a more prudent approach, it is even more unpopular with Obamacare haters.
Republican Sen. Lindsey Graham of South Carolina summed it up best: “The flaws in Obamacare are obvious to me. The solutions are much harder.”
Some of us might like to consider Obamacare to be just another government program for poor people.
But repealing the law will affect us all.
Medicare premiums and deductibles will likely increase for millions of seniors and disabled people. The dreaded “doughnut hole” – the gap into which seniors fall when their drug costs exceed a threshold – will not be eliminated by 2020, as promised by Obamacare. And the nonpartisan Congressional Budget Office estimates Medicare spending will increase by $802 billion over 10 years.
Many free diagnostic and preventative services for such conditions as heart ailments, diabetes and cancer, will end.
Mandates for employers to provide workers with health care coverage will end, as will such requirements for policies to provide many diagnostic and preventative services, and birth control services. Repeal of Obamacare will end mandates that pre-existing conditions be covered and adult children remain on parents’ policies.
Lifetime limits again can be imposed on everyone’s coverage. Women can be charged more for coverage than men.
And for people not provided health care through their employers, the “individual market” will again also allow exclusions for pre-existing conditions, increased costs for being sick, lifetime caps, gender and age inequities, and the exclusion of a wide range of services, treatments and medications.
In states, such as California, Medi-Cal (Medicaid) was expanded under Obamacare to provide subsidized medical services to the “working poor” – people not on public assistance, but who earn salaries barely above the poverty level.
Repealing Obamacare without having a replacement plan ready to go is like pushing over the cart and just watching to see where the apples roll. Too many Americans – those who depend on Obamacare for medical insurance coverage, those whose services and costs will be affected by repeal, and taxpayers who will end up paying the tab for an increasing number of Americans returning to hospital emergency rooms for “primary care” – depend on a more thoughtful, careful approach to “repeal and replace.”
House Majority Leader Kevin McCarthy, R-Bakersfield, recently told reporters, “I think once it’s repealed, you will have hopefully fewer people playing politics and (instead) coming together to find the best policy.”
Hope is not a “replacement plan” when American lives are at stake.
Stephen Schilling is the chief executive officer of Clinica Sierra Vista, a nonprofit health care corporation that serves low income Southern San Joaquin Valley residents through medical, dental and behavioral health facilities in Fresno and Kern counties. Connect with him at firstname.lastname@example.org.