It’s simply not possible to make insurance companies cover sick people without also making sure that the risk pool includes plenty of healthy people — a balance that the ACA achieved through the stick of the mandate and the carrots of subsidies.
On a recording of congressional Republicans at their retreat in Philadelphia last week, we hear them worrying aloud that a sturdy replacement for Obamacare can’t be built overnight, that reining in costs won’t be easy, that the whole health care industry could be thrown into chaos if they aren’t careful, and that a tax credit isn’t much of a solution for low-income Americans.
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As it turns out, House Republicans have a more nuanced view of the law than their more than 60 votes to undo it would have suggested.
A newcomer to Capitol Hill, New York Republican Rep. John Faso, has already done the political math and concluded that legislating is a lot riskier than merely promising to act, and that Planned Parenthood is considerably more popular than, well, Congress.
“Health insurance is going to be tough enough for us to deal with,’’ he said on the tape, “without having millions of people on social media come to Planned Parenthood’s defense and sending hundreds of thousands of new donors to the Democratic Senate and Democratic congressional campaign committees. So I would just urge us to rethink this,” he said of Republican plans to defund the group.
Officials at some of the same Catholic institutions that sued the Obama administration over its contraceptive mandate are suddenly murmuring instead about the law’s merits. Even the conservative National Catholic Register, in a mostly positive analysis of the pros and cons of a Trump administration, noted that “the transition to a new health care framework is fraught with danger for Trump and GOP lawmakers, who face intense pressure to protect new policyholders and minimize disruptions to the insurance marketplace. Some of the nation’s largest Catholic health care networks also benefited from the ACA, and it is not clear how new federal policies could affect their bottom line.” Or their patients.
Officials at Catholic and every other kind of hospital have already warned Congress that repealing the law without replacing it would result in “an unprecedented public health crisis.” And as always, those who are sick and low-income are at particular risk.
Polling shows that the public is warming to the ACA as well, now that it might be repealed, especially since the alternatives are so unclear. A recent Quinnipiac University survey shows a majority of those polled are satisfied not only with their care, but also with the cost of that care, and only 16 percent want to see the Obama administration’s health care law repealed in full.
One of the many questions about any replacement the Republicans might pass is how closely it will conform to President Donald Trump’s recent promise that it will provide “insurance for everybody.” But already, Washington Republican Rep. Cathy McMorris Rodgers, who serves in House leadership and was booed in her Spokane district over her opposition to Obamacare, has walked back assurances that no one would lose coverage if the law were repealed and replaced.
“Let me be clear,” she’d told reporters. “No one who has coverage because of Obamacare today will lose that coverage. … We aren’t going to pull the rug out from anyone.”
But later that day, a spokeswoman clarified that what she’d meant to say was that “people who are covered under Obamacare will not lose coverage the day the bill is repealed.”
No wonder Republicans are nervous.