These are not good days for Obamacare.
The law remains as unpopular as ever in polls, and voters just removed four more incumbent senators who voted for it in 2009. (A fifth removal is likely next month.) In addition, Obamacare is entering its second year with a new round of insurance cancellations and the unveiling of even higher premiums when open enrollment begins on Saturday.
And then, of course, there are all of these newly unearthed comments from Jonathan Gruber, one of the White House’s key paid consultants in drafting the law. With refreshing candor and with cameras rolling, Gruber discusses the procedural and substantive cynicism that went into passing Obamacare. If recent election results are any indication, he probably overestimated “the stupidity of the American voter,” but his other points are well taken.
The new GOP majorities in Congress are certain to vote on repealing Obamacare when they convene next year. But this will only get them so far. At best, repeal will end up under President Obama’s veto pen.
When that happens, Republicans have to make a decision. Some will prefer an all-or-nothing strategy, but it is worth considering attacking the law’s most harmful and hated provisions. If they cannot get President Obama to sign off, at least Republicans can put Senate Democrats on the record resisting their efforts.
There are a few easy layups available when it comes to nibbling at Obamacare’s edges, such as repealing the law’s medical device tax — a change that some Democrats will support. But there are bigger fish that can could also be fried.
The individual insurance mandate, already the subject of an unsuccessful Supreme Court challenge, is both publicly hated and politically vulnerable. In line with conservative health policy expert Avik Roy’s suggestion, Republicans should consider abolishing it altogether, and simultaneously obviating the need for it by letting insurers hold biennial, rather than annual, open enrollment periods. This would make it far more risky to game the system by purchasing health insurance only after one discovers a serious health problem. (Germany has open enrollment only once every five years.)
Roy recommends keeping the ban on discrimination against those with pre-existing conditions, but allowing insurers to charge older customers up to six times as much as younger ones, since insurers believe this to be a reliable proxy for patients’ health. The current law only allows older patients to be charged just three times as much, understating the actuarial risk of insuring older patients and turning middle-income young people into Obamacare cash cows.
These changes, coupled with a relaxation of benefit mandates (60-year-olds don’t need maternity coverage or pediatric dentistry) would accomplish three things. First, they would show the public that Republicans want to fix the problem and will move legislation to do so. Second, they would make health insurance less painful for the middle class until a new president arrives to sign a replacement for the law. Third, they would undo enough of Obamacare that when the time for repeal actually arrives, there will be fewer plausible arguments for its supporters to fall back on.
These are, of course, temporary measures. But they allow Republicans to make good use of Obama’s lame-duck years while keeping front and center one of the largest burdens he has placed on working families.
