What’s next for Obamacare?
The Senate Republican bill to repeal and replace the health law lies in a smoldering heap. Some GOP lawmakers back a loopy repeal-now, replace-later-maybe effort that as of Tuesday already looked to be political toast. You can’t replace something with nothing, or the promise of something later that you’ve failed to deliver today.
So what is next? Americans are hearing prescriptions from lawmakers that range from facile to feckless to fallacious. We’ll take them in that order:
—Some members of Congress, many of them Democrats, are urging Republicans to engineer a bipartisan Obamacare rewrite with … Democrats. That’s a nice sentiment. But it’s hard to imagine now since Republicans have vividly demonstrated they can’t even agree among themselves. They’re more interested in their intramural divisions than in coalescing behind a workable plan. President Donald Trump tweets that Republicans should just repeal Obamacare and start with a “clean slate,” fantasizing that “Dems will join in!” Sure, they’d be happy to take a seat at the negotiating table, to ensure that nothing changes, except that more federal money gets shoveled into their failing health care program.
—“Repeal and replace won’t work so let’s just fix Obamacare,” some lawmakers say. Not going to happen. Democrats have murmured over the years about fixing Obamacare. But their current stance can be summed up in a word: No. No significant changes in such crucial areas as permitting more flexibility among insurance policies. Head, meet sand.
—“Just give Obamacare more time to work,” its defenders say. Again, not going to happen. The Democratic mantra that Americans would love Obamacare once they came to know it, has been proven, again and again, to be fallacious. Millions of Americans whose premiums were supposed to help Obamacare cover the costs of sicker participants instead want nothing to do with it. The central fact of this entire discussion: Obamacare is growing weaker. The next round of premium increases surely won’t attract hordes of new customers.
Yes, we’re glum today about the prospects of a workable fix for a failing law. But there is a path ahead. It leads directly to the 2018 voting booth. The fate of sustaining or replacing Obamacare now likely depends on the outcome of 2018 congressional elections. Three possibilities:
Americans could choose to keep Congress gridlocked by re-electing most incumbents. Happens a lot.
Or, Republican voters, angered by the failure of repeal and replace, could stay home. That leads to more Democratic defenders of the status quo — with added pressure to funnel more federal money into a failing program.
Or the GOP failure could energize Republican voters in many states to send more Obamacare repeal-and-replace senators to Washington. The 2018 map does favor Republicans.
Which delivers us to some good news: Voters are now armed with far more information about the costs and complications of overhauling Obamacare. They’ve seen the Congressional Budget Office predictions of how many people would lose coverage, and heard from experts about how various proposed provisions would unfetter insurers and drive down premiums. They’ve learned how bringing Medicaid under cost controls would save billions but also affect those now on its rolls.
These voters are now primed to ask candidates the questions they didn’t ask before: How big or small a role should the government have in providing health coverage? What’s your idea to resolve this crisis? How much would that cost me in premiums or taxes?
Some urgent matters occasionally move voters to act decisively — long wars, runaway public spending and massive taxpayer debts. On this day in July 2017, with the Senate effort on Obamacare in tatters, that’s how this moment feels.
That’s not a prediction. Maybe in the next months we’ll see a chastened Senate majority coalesce around an Obamacare replacement that isn’t yet in public discussion. We’d like to think that smart senators have been conferring and can yet this year come together on a fix.
Because a Senate failure doesn’t change the plummeting trajectory of this law. Nor does time make an eventual fix easier. The longer lawmakers fail, the more insurers nervously eye the exits.
As they wait for the voters’ verdict in 2018, lawmakers face a familiar dilemma: Fix the law now and try to help more people buy or retain coverage. Or watch as it crumbles, leaving many Americans unable to find affordable coverage.