The long awaited “replace” has arrived. The battle is now joined. A mainstream media wholly invested in the political failure of a replacement to Obamacare will not be helpful.
As the trench warfare begins, it is an appropriate time to review the facts as we know them. It will then be my right as an American citizen (and columnist) to offer an accompanying opinion — for your consumption. Warning: The remainder of this essay may cause depression and severe constipation for progressives continuing to cling to a law they still haven’t read, but that now defines them.
FACT #1:
Republicans made the last four election cycles a referendum on Obamacare. Each time, Democrats up and down ballot got hammered. The final Democratic casualty count was 63 House seats, 9 Senate seats, 13 governorships, 524 state legislative seats, and 18 State Chambers.
OPINION:
This brutal record of electoral defeat is lost on progressive activists and their enablers in the Democratic leadership. Their attachment to the legislation is unshakeable. Look for renewed street protests and disruptive town halls as the legislative process gets serious this Spring.
FACT #2:
Three baseline promises were employed by President Barack Obama in taking his case for healthcare reform to the American public. In no particular order: “You can keep your doctor,” “You can keep your health insurance” “You will save an average of $2500 annually on your health insurance.” Each commitment proved untrue. The president’s continued use of the “If you like your health plan, you can keep it” line earned him PolitiFact’s “2013 Lie of the Year.”
OPINION:
Few substantive responses have been offered to this devastating line of attack. A typical line begins with a wish the Republicans would have been more cooperative during the first year of the Obama presidency. But it was the president and Democratic leadership who kicked Republicans to the curb on healthcare reform. No GOP alternatives were entertained. This bit of uncompromising partisanship came back to bite the Democrats in the aftermath of Obamacare’s disastrous rollout. Political reminder: Throwing a rope to a drowning opponent is not an option in the absence of demonstrated good faith.
FACT #3:
A key player in the drafting of the Affordable Care Act “wrote the bill in a tortured way” (in order to hide its tax burden), all the while “relying on the stupidity of the American voter to sell it”.
OPINION:
These words from professor Jonathan Gruber reflect the intellectual (dis)honesty of the bill’s chief architect. No wonder so many moderate Democrats ran for the hills once all the duplicity came to light. But many could not run fast enough – see FACT #1.
FACT #4:
Major insurance carriers continue to exit Obamacare networks for the most basic of reasons: They are unable to make a profit. It gets worse. The federal exchanges continue to lose plans and customers, while only four of the original twenty-four Obamacare co-ops remained in business as of Jan. 1.
OPINION:
Hillary Clinton’s campaign paid a high price for last fall’s announcements regarding Obamacare premium increases. A new round of price hikes this Spring will likewise upset the “fix-but-don’t-replace” Democrats.
FACT #5:
Medicaid was originally passed as a joint state-federal social safety net program for the benefit of poor women with children and people with disabilities. The program experienced incremental growth over the years until Obamacare blew the doors off with a 100 percent federal contribution for new enrollees that is guaranteed to never go lower than 90 percent. Many (not all) governors expanded their eligibility rolls in order to sign up for the “free” federal dollars.
OPINION:
That millions of these new Medicaid recipients could have been removed from the program is the foundation for Democratic charges that Republicans will cause poor people to lose their health coverage. But the new draft postpones the issue; expansion is funded through 2019 when things really change.
FACT #6:
The new draft contains a long sought after GOP objective by block-granting Medicaid – thereby providing states the fiscal resources to serve the poor while allowing for maximum flexibility. The size of individual state grants will be derived from 2016 per recipient spending levels.
OPINION:
Maintaining Obamacare levels of spending for an additional three years is intended to mitigate the reality of a truly transformative change beginning in 2020. Some Republicans will oppose the continued spending, while Democrats will oppose the proposed block grants. This is all heavy lifting indeed.
FACT #7:
Obama era congressional majorities voted to repeal Obamacare in excess of 60 times.
OPINION:
Much of the draft contains provisions that have appeared in past repeal bills. This initial proposal repeals the individual and business mandates, and their complex income-based subsidy formulas. These are replaced by a refundable tax credit tied to age and income and targeted to the working poor and working class folks who make too much money to qualify for Medicaid and are not covered at work. Freedom Caucus types are not excited by the prospect, but Republicans typically utilize tax credits (not just deductions) in order to achieve policy outcomes. The ACA’s exchanges survived but will assuredly sink with the absence of taxpayer subsidies. Extremely popular Health Savings accounts are expanded, and the tax preference for employer-provided health insurance is kept in place. Look for conservatives to revisit the Medicaid compromise and seek to eliminate Obamacare’s taxes now rather than next year. Look for Democrats to scream bloody murder.
2nd Opinion:
All in all, it’s a serious step in the right direction.
Gov. Robert Ehrlich is a Washington Examiner columnist, partner at King & Spalding and author of three books, including the recently released Turning Point. He was governor of Maryland from 2003 – 2007.
