The fight over Obamacare

So, what’s happening with Obamacare?

Outside of the protests and the Sunday morning interviews, thing are changing with Obamacare.

First, Donald Trump did a show of issuing an executive order the weekend after he was elected president. I call it a show because it was vague and confusing and will not do much to “kill the overall law”.

Second, although there was a sharp rise in the number of people signing up for the affordable care act via the exchanges. After Trump’s executive order, the numbers dropped significantly.

Third, in Sunday’s Fox News interview with Bill O’Reilly, Donald Trump walked back his expectations on the speed with which health care will be repealed

Yes, in the process and maybe it’ll take till sometime into next year, but we’re certainly going to be in the process. Very complicated — Obamacare is a disaster. You have to remember Obamacare doesn’t work, so we are putting in a wonderful plan. It statutorily takes a while to get. We’re going to be putting it in fairly soon. I think that, yes, I would like to say by the end of the year, at least the rudiments, but we should have something within the year and the following year.

In Jonathan Chait’s New York magazine article entitled, Obamacare Repeal Is Failing Because It Was Based on a Lie, he writes privately some current and former Republican lawmakers believe that in the end the ACA repeal may do very little or nothing to the actual law:

Richard Hanna, a Republican from central New York who just retired from Congress, admitted something that almost no member of his party in elected office has been willing to concede in public. “At the end of the day, the Affordable Care Act will in some form survive,… So who really won? In my argument, the president, Obama, won. At the end of the day we will have some sort of national health care that’s going to look very similar to what we have.”

I, personally, don’t believe that. I think it underestimates the, as Barak Obama once called it, “fever” the Republicans are under. Any belief that Donald Trump, Paul Ryan and Mitch McConnell are going to become reasonable about this issue is absurd. Because of gerrymandering, many Republicans are insulated from the push back stripping millions and millions of people from healthcare will have.

Of course those who are not in safe districts are toast.

The repeal may be the potential undoing of the Republican party’s power in House and Senate. Hubris.

But Chait goes on:

The plan to quickly repeal, and then figure out a replacement, appears to have been halted, and the party has yet to decide what will take its place. A week after the inauguration, a secret recording of a Republican Congressional brainstorming session revealed the party had not advanced beyond step one in conceptualizing a plan, let alone achieving consensus on any of the numerous dilemmas they would need to resolve.

The irony here is that while Obama was President, the law struggled to get to 50% approval. Now that he is out of office, the law’s popularity has seen its best days:

On the straightforward question of whether Barack Obama’s health-care reform was a good idea or a bad one, for the first time ever, “good idea” now wins:

from NY Magazine

And Americans by a significant margin believe it is the government’s responsibility to make sure everybody has coverage:

From NY Mag

The only thing that looks promising, in my view, is that Chait acknowledges something that I’ve been thinking about for some time. Because of Donald Trump, the Republicans, who usually have message discipline as a super power, are off message.

Speaker of the House Ryan talks about high risk pools. Senate majority leader McConnell talks about taking government out of it. President Trump talks about “covering everybody” and “the government will pay”.

Donald Trump made a show of meeting with drug manufactures and got nothing out of it. No concessions on lowering the price of prescription drugs. Remember Trump slammed them during the campaign.

And then there are the lobbyist who need their pound of flesh.

The hospital lobby want Republicans to recoup their costs for patients who cannot afford to have health insurance if coverage is stripped away.

AARP won’t back a law that costs more for older Americans.

Republicans have railed against the burden this places on younger workers buying insurance — and it’s true that Obamacare makes the young pay more so the old can pay less. But now Republicans are learning the difference between posturing against a law, and cherry-picking its downsides, and actually having to endorse an alternative position. When you have to pick winners and losers, not just complain about the losers in the other party’s law, you make people mad.

So the repeal will not happen overnight. It may not happen until the midterms are over. It may be a complete overhaul. It may be a tiny fix. We don’t know. We’re too far out to know.

Whatever the fix, I think caution is needed.

Do not be comforted by the protests, the chants and Republican confusion.

Expect the Republicans to do something wild and crazy. As Chait cautions:

The Republican majority may decide melting down the health-care markets is worth the backlash. It wouldn’t be the first time they have taken a political gamble that seemed irrational. It’s possible that the Trump administration might intend to preserve Obamacare but wind up killing it through sheer managerial incompetence; a White House that can screw up something like an introductory phone call with the prime minister of Australia could screw up anything.


It is dawning on the Republicans that the cost of destroying this achievement in social policy may well be to destroy their majority.

I expect the fight for health care to be an ongoing fight for generations to come.

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