Republicans are in the process of internally debating how to repeal and replace Obamacare now that they have unified control of government, but no matter what strategy they ultimately pursue, there’s one move they could make right off the bat to make their jobs easier: immediately act to prevent more individuals from newly enrolling in Obamacare.
Right now, as Republicans pursue repeal, the biggest hurdle is figuring out how to handle the millions of Americans who are currently receiving some sort of benefits through Obamacare. That’s why President-elect Trump spoke about doing repeal and replace “simultaneously.” And Speaker Paul Ryan referred to a “transition period” in his “60 Minutes” interview this past Sunday. That is also consistent with the rumblings that Republicans are considering some sort of “repeal and delay” tactic to repeal the law and then buy time to figure out a replacement.
But a “transition period” that left Obamacare temporarily intact would mean that individuals could still sign up for Obamacare by receiving subsidies to purchase insurance on the exchanges and gaining Medicaid benefits. That means by the time Republicans get around to replacing Obamacare, there could be millions more people obtaining insurance through the program, meaning more people to consider disrupting with repeal and replace. Additionally, Republicans would be dealing with a moving target of Obamacare beneficiaries as they work up repeal and replace.
In contrast, Republicans could immediately freeze enrollment — allowing those who already have insurance through Obamacare to continue receiving subsidies, but preventing new enrollees from receiving any (though they’d still be free to purchase insurance on their own if they aren’t seeking subsidies). The current open enrollment period for privately-administered insurance ends on Jan. 31, so that would be a natural cutoff point. In addition, Republicans could make sure that Medicaid can only sign up individuals who would have been eligible under the rules that were in effect before Obamacare took place.
Establishing a hard cap would provide Republicans with the ability to examine who the current beneficiaries of Obamacare are, and where they are located to target any sort of transition policy. Some enrollees, for instance, receive little or no subsidies, but purchase insurance on an Obamacare exchange because that’s the only feasible option to them given what the law has done to off-exchange business. This group of people would easily be able to afford insurance, should they choose to obtain it, in the absence of Obamacare. Any sort of “transition” for them would be different than for those who are truly indigent who would find insurance out of reach without Obamacare.
Making these changes would cap the number of people within Obamacare, and over time, the number is likely to dwindle through attrition. For instance, some people who are currently gaining insurance through Obamacare may take a job that has health benefits, and thus they would jump off the exchanges. Ultimately, it means there would be a smaller universe of Obamacare beneficiaries for Republicans to worry about as they craft a replacement.
If Republicans know that they are going to repeal the law, they shouldn’t knowingly allow more people to become dependent on health insurance arrangements that they will soon be eliminating.
