12.18.16

By: The Editorial Board
Source: USA Today

Repeal and delay Obamacare is a cop-out

For six years, congressional Republicans have been trying to kill the Affordable Care Act, also known as Obamacare. They've passed no fewer than 60 measures to repeal all or part of it, none of which has become law. Now, with a Republican about to move into the White House, they are in a position to get their way.

The only problem is, they are like the proverbial dog who finally catches the car and doesn’t know what to do.

Defunding the health law through a budgetary process known as reconciliation would be easy enough: It takes only a simple majority in both chambers of Congress.

But this would wreak havoc on the American health care system. As a coalition of hospitals made clear recently, it would unleash an “unprecedented public health crisis” as uninsured patients pour into emergency rooms.

So Republicans have come up with the idea of passing a measure next month that would repeal Obamacare, but with a postponement of a few years before it goes into effect. In the interim, they would attempt to do what they have not been able to do in decades of trying: agree on their own health care plan.

This "repeal and delay" approach is a cop-out of the first order. If Republicans want to kill Obamacare, they need to come up with a replacement now, both to show they can do it and to avoid destabilizing health care markets through years of uncertainty.

Any plan to defund Obamacare, whether it goes into effect immediately or not, would prompt insurers to pull out of its health exchanges. That, in turn, would leave millions of people in the lurch.

The fact is, insurers are already pulling out of Obamacare, thanks to flaws in the law. Penalties for not buying insurance were set too low, prompting many young and healthy Americans to pay the penalty knowing that they could buy insurance later if they get sick.

With pools of older and sicker patients, insurers have jacked up premiums or pulled out of exchanges altogether. If Congress sets an end date for the program with no clarity of what, if anything, would follow it, insurers would turn a gradual move to the exit into a stampede.

Obamacare has allowed 20 million people to gain access to insurance and has given Americans the right to buy insurance regardless of previous conditions. It also has very significant Republican DNA in it. The law bears a striking resemblance to the Health Equity and Access Reform Today Act of 1993, a measure offered by 18 Republican and two Democratic senators as an alternative to the more unwieldy approach then being pushed by Bill and Hillary Clinton. Two of those senators, Orrin Hatch, R-Utah, and Charles Grassley, R-Iowa, are still in office.

Ideally, Republicans would fix what is wrong with Obamacare by adding incentives and penalties to entice young people to join insurance pools. They might also make some changes that conform to their liking, such as shifting some patients off Medicaid and onto private markets and allowing plans to sell across state lines. But their approach of offering vague concepts of what might or might not pass at some future point is entirely unworkable.

Until Republicans come up with a credible replacement plan, one that could pass simultaneously with repeal, they should follow the lead of medical professionals: First, do no harm.