In retrospect, you honestly must admire the Machiavellian way that the Obama administration sold their health care reform law:
“If you like your health care plan, you can keep your health care plan.”
“If you like your doctor, you can keep your doctor.”
“We are going to bend the cost curve down.”
“No longer will being a woman be a pre-existing condition.”
The simplest way to understand the essence of Obamacare is this: If you already had health insurance, Obamacare would make it worse (more expensive, higher deductible, higher co-pays). If you did not have health insurance, and it provided coverage for you, then you would benefit.
In rough numbers, 20 million Americans were newly covered, but fully 12 million of them were covered through Medicaid. They took the health insurance of 75 percent of the country, and made it worse to provide health insurance to another 8 percent. How could they have possibly sold that?
What matters now it what happens next.
Obamacare is objectively failing. Several states only have one exchange. Health insurance companies are pulling out altogether, with all eyes on what the individual Blue Cross state plans do in the next 60 days. Premiums and copays are going up everywhere, sometimes as much as 20-30 percent next year (millions of Americans already got their rate increase letter two weeks before the election).
Republicans, including President-elect Donald Trump, ran on repealing and replacing Obamacare. But there lies a problem of political reality.
Obamacare was passed “on reconciliation,” a technical legislative maneuver that lowered the traditional 60-vote threshold in the U.S. Senate to 51, allowing President Obama and the Senate Democrats to pass Obamacare with only Democratic votes, as they also had done in the U.S. House.
But because Democrats chose to use reconciliation to pass Obamacare, reconciliation can be used to repeal it and there are 52 Republicans in the U.S. Senate. And since the party promised to repeal Obamacare this campaign cycle, they should do it in the first 100 days.
But that creates two problems that must be solved:
1) What is the replacement? This is obviously a very important question, and Republicans have scores of replacement proposals, including one excellent proposal introduced by the HHS Secretary-designee, Rep. Tom Price, Georgia Republican. There will need to be a consensus around one proposal, between the Trump administration, Capitol Hill Republicans, and whichever Democrats can join the coalition. This will take time.
2) What do you do about those who are covered by guaranteed issue (the end of the pre-existing condition exclusion) or by staying on their parents plans until age 26, or those who are benefitting by the end of lifetime caps?
Those provisions are popular and may be politically impossible to repeal. I would propose a mechanism that can solve these thorny problems: Sunset Obamacare.
The term “sunset” is well-known in states that have automatic “sunset” provisions related to state agencies, that are automatically reviewed at least once a decade.
To “sunset” Obamacare, would mean that Obamacare would be repealed, but with a deadline for replacing it, say Dec. 31, 2017 or perhaps June 30, 2018. A deadline that is soon enough to spur legislative action, but far enough out that the health care industry can prepare for the transition and the markets can calmly receive the news.
The reality is that Congress rarely acts without a deadline, so Sunset Obamacare provides the catalyst for not just repeal, but for replace, while giving Capitol Hill time to consider the replacement legislation seriously and thoroughly.
Waiting to repeal Obamacare until the replacement is ready would be a disaster. More Americans will be hurt by Obamacare’s failure in the interim, and the Trump-Pence mandate for Obamacare repeal needs to be acted on in the first 100 days while the new president has the best chance to pass major legislation.
Sunset Obamacare is the way to achieve all of this.
• Matt Mackowiak is the president of Potomac Strategy Group, a Republican consultant, a Bush administration and Bush-Cheney re-election campaign veteran, and former press secretary to two U.S. senators. He is the host of a new national politics podcast, “Mack on Politics,” produced in partnership with The Washington Times. His podcast may be found at washingtontimes.com/mackonpolitics.
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