"Obamacare" is Doomed, But it's Not Going Anywhere

24 hours after publishing this on Medium, my prediction came true. We live in turbulent times...

It’s a somewhat humorous irony that the rousing support Obama always needed for the Affordable Care Act (ACA) comes just as he’s leaving office. Even funnier are the worries of rank and file Republicans who are terrified to follow through on their promise of “repeal and replace.” As far as I can tell no one, not even Paul Ryan, really saw this day coming. No one really wanted to replace Obamacare, least of all Republicans. Their opposition was, and always will be, a stunt. A stunt that, much like that kid who licks the frozen pole in A Christmas Story, they’ve been double-dog-dared into following through on.

This almost Shakespearean reversal of fortunes would be far funnier if several million people weren’t in danger of losing their health insurance over it. There is nothing funny about being denied health insurance because you have a genetic disposition to a disease, or even worse, are already showing symptoms. There is no comedy in stripping away the safety net of young adults everywhere (myself included), who already find themselves staring down dwindling job opportunities — especially those with health benefits. Repeal and replace may be the mantra, but politicians know first and foremost that they need to give their voters what they want — or at least the illusion of it. So what do you do when your voters want to both keep Obamacare and replace it? What do you do when the 18 million people who are going to lose insurance certainly won’t vote for you in in 2018?

Simple — repeal Obamacare, then replace it with the exact same thing. All that needs to change is a name. And there are a lot of reasons why this is shaping up to be the only option left in the Republican playbook:

  1. You can’t keep Obamacare’s best parts without keeping the individual mandate.

There are many more in-depth breakdowns on this fact than I will provide, but for the uninitiated here is a quick overview. Republicans, Trump included, have stated time and time again that they want to keep two most popular aspects of Obamacare intact: no denying insurance if you have pre-existing conditions, and children can stay on their parents insurance until they turn 26.

Here’s the catch — those perks are both things that can cause an insurance company to lose money. A lot. Obviously, anyone with a pre-existing condition is a money loser for an insurer, since those people have high medical bills but require insurance. And keeping kids under parents’ insurance slows new people from entering the insurance market.

This is where the individual mandate comes in — the main complaint that Republicans have hitched their rhetorical hat to. By forcing healthy people into the insurance market, you give the actual insurers breathing room to cover expensive sick people. And this is where Obama, Democrats, and others have failed defending the ACA. It’s not a law meant to make individual people healthier and happier (not directly, at least). It’s designed to make the country healthier and happier as a whole.

Anyone with basic arithmetic skills can see how the money doesn’t add up if you eliminate the mandate. Granted, there are options — a tax cut big enough that you’d be silly not to get insurance, extending Medicaid to those that can’t afford it (a government subsidy, essentially) — but those solutions may create more red tape and deficits than they’re worth. Right now, the parts Republicans want to keep cannot be easily separated from the parts they hate. Why do you think it took Obama so much time to hash this thing out in the first place? Reforming health care is hard as hell — you really think that they want to start from scratch?

2) Politically, you can’t take away something you’ve already given people — especially if they like it.

Busting up Obamacare will be, in a few concise words, really shitty. The nonpartisan Congressional Budget Office is already predicting that repeal will rip insurance from 18 million people in the first year, as well as double premiums after two years. This is political suicide, especially with midterms coming right as these premium hikes hit their hardest. The recent spike in Obamacare premiums, if left alone, shows all indications of settling back down in time. But rocking the boat like the GOP claims will put the blame squarely on their shoulders. And, for a party that made politics more important than governance for the past eight years, that is unacceptable.

Furthermore, as every single news outlet has delighted in reporting, there are a lot of Trump supporters who are suddenly freaking out about losing the ACA. Republicans know this. They know that while they whipped their base into a frenzy over Obamacare, that same base was secretly reaping its benefits. More importantly, they know that it’s politically impossible to remove something once you’ve already given to the populace. It’s one of the many reasons why we’re never taking all those guns back no matter how many children get shot. Again, Republicans know this.

3) Repeal and Re-brand is literally the most Trump thing in the whole wide freaking world.

Repealing Obamacare and replacing it with a nearly identical copy is the legislative equivalent of, ohhhh I don’t know, buying up businesses and plastering your big, ugly name all over them. And there have been rumors as far back as November that this may happen.

Trump is a serial braggart, especially when he deserves zero credit for the success he claims. Look no further than Ford, or Carrier, or the non-existent ratings success of The Apprentice. He knows that most people aren’t going to call him out on his bullshit and, if they do, he usually has some sort of plausible deniability. Or whatever the opposite of that is — plausible credibility?

Furthermore, the “repeal and replace” of Obamacare is and always was a marketing scheme. It even has it’s own clever little alliteration. There is no reason to think that the Marketer-in-Chief is going to stop now. In all seriousness, Trump is one hell of a marketer, perhaps the best on the entire planet when it comes to selling a pile of shit. Obamacare isn’t a pile of shit, but the repeal and replace mantra is, and he knows it. Just yesterday Trump vowed insurance “for everyone,” which included government intervention in drug pricing as well as keeping Obamacare’s more popular parts.

But the GOP’s main philosophical problem with Obamacare is that the government shouldn’t be involved in the insurance market, birthing my favorite headline of the week (Buzzfeed’s “Republicans Say They Assume Trump Didn’t Mean to Promise Health Insurance for All”) So far, Trump has both vowed to repeal the “unjust” Obamacare as well as keep it’s main philosophical tenets intact. In essence, Trump is admitting to Clinton’s plan for the ACA — fix what’s broken, keep what’s not — while pretending to do the exact opposite.

In essence, the only politically expedient move for Republicans to make is to replace Obamacare and then put it right back in place. They phase the ACA out over a year, getting credit for getting rid of it, then put it right back 6–8 months before midterms.

The complete lack of details for a replacement plan is no mistake. Nor the repeated “delays” for repeal, nor the blase remarks from congressional Republicans that “we’ll figure this out later.” They don’t have anything to figure out — the framework is already there. All Republicans need to do is market the hell out of whatever they’re calling the new plan. Trumpcare is as good a bet as any. Then they need to create enough distance between passing Obamacare’s repeal and and passing it’s “replacement.” The laws and language of congress are byzantine enough that even pushing a nearly identical bill through would likely fool most Americans.

In the long term, this may be good news wrapped in a bit of nasty partisan paper. What it means is that Obamacare will get the tweaks and touch-ups that it really deserves, keeping the majority intact while ironing out the kinks. And there are kinks — the ACA is far from perfect. We still treat health insurance as part of wages, a significant reason that salaries have stagnated the past few decades (employers can include health insurance costs as a portion of salary, so if health insurance costs rise, employers don’t have to raise wages — while it could be it’s own article, this is a fascinatingly long-term side effect of the government freezing wages during WWII). Unfortunately, we still allow drug companies to raise and lower the price of medicine almost at will, a problem that California tried to fix all on it’s own with a ballot measure last November. The truth is, Obamacare isn’t perfect — but no new law is. It needs time to grow — and maybe it will actually get it.

The bad news, however, is that the party that so vehemently opposed the law in the first place will get credit for that same law actually working. Furthermore, these “small tweeks” may not be beneficial at all — stripping mental health funding, contraceptive access, and disproportionately hurting rural hospitals. It will hit the middle class and leave the big guys safe and sound. If that’s not in perfectly in line with Trump’s “promise to drain the swamp while hiring the swamp monsters” strategy, I’m not sure what is.