Wednesday, July 19, 2017

Republicans Fail to Repeal or Replace ObamaCare

The Republicans control the House, the Senate and the Presidency. Democrats can use procedural tricks,Senate tradition and appeals to the judiciary branch to slow down portions of the Republican agenda, but by and large Democrats can't stop anything that Republicans are bound and determined to get. The PPACA was passed without any Republican votes. Republicans swore that once they had the power to repeal it, the PPACA or ObamaCare was dead meat. During the Obama Administration, the Republicans voted time and time and time again to kill ObamaCare. Some said they would replace it with something better but just about all of them agreed that ObamaCare had to go. Like yesterday if not before. But a funny thing happened over the years that ObamaCare was the law. A noticeable portion of the Republican constituency found that even as they hated ObamaCare and of course Obama, they loved the PPACA. Many of these people were so stupid that they didn't realize that the PPACA and ObamaCare were the same thing. 

Once Trump won the White House and had Republican majorities in the House and Senate ObamaCare should have been easy to repeal. But we saw this week that when it really came down to it Republicans, at least in the Senate, were people who, as James Brown might have said, just liked talking loud while saying nothing.  At this time the Senate could not bring itself to modify the PPACA or to remove it.

There are a lot of problems with ObamaCare, as I have pointed out before. I do not believe that it will be fiscally sustainable in its present condition. But that said the Republicans chickened out when it came time to stand up and do what they had promised to do. They weren't willing to remove ObamaCare root and stem because too many Republican voters liked such things as adult children being on parents' insurance until 26, mandatory insurance issue for pre-existing conditions, and having lower costs for older people and women. Many people with disabilities or other issues didn't want Medicaid cuts. There was no way to keep all those things, lower taxes for the wealthy, prune back Medicaid and still improve coverage for the majority of people in the individual insurance market. It's just math.
On the other hand as mentioned I think that unless there is an ongoing infusion of tax money into the system, something Republicans abhor, we will continue to see premiums and deductibles rise, while insurers flee unprofitable exchanges. All else equal young healthy single people won't line up in huge numbers to purchase insurance that is priced for older, sicker, married people with families. After all, a great many of those young people are still on their parents' insurance thanks to the PPACA. The incentives just aren't properly aligned. When Democrats say that the PPACA is doing just fine, they are wrong. Republicans aren't going to get a 70-30 split in the Senate where all seventy Republican Senators are to the right of Ted Cruz. But neither are Democrats going to be able to blithely dismiss problems with ObamaCare by claiming that everything that is bad is the Republicans' fault. Sooner or later, no matter how much each side hates it, there will need to be some bipartisan dealings to solved some of the problems with ObamaCare. We already know that the Republicans weren't really serious about repealing it. They squealed and squawked about how they were going to kick down the door, walk up and shoot the PPACA in the head. But when it came time to pull the trigger, they swallowed hard, blinked and put the gun down. 

We'll see what happens in the next few weeks but everyone is going to have to think hard about how we want to pay for health care for those outside of the employer based system. Some people think that it's time to get rid of an employer based health insurance system. Some are upset that the current welfare system isn't accepted by many doctors who accept private insurance. Republicans will need to explain to their rabid base why, despite being in the majority, they were unable at this time to get rid of ObamaCare. Republicans can't, despite President Trump's ramblings, blame Democrats for that. Democrats are starting to talk about single payer. But frankly I wouldn't want to give up my employer coverage for the equivalent of Medicaid. And I doubt that I am the only one. We live in interesting times.
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