We have long suspected
One piece of that evidence is provided by an extensive post-election poll conducted by the nonprofit Kaiser Family Foundation. It found that the key provisions of the ACA enjoy broad support among both Democrats and Republicans, including voters who supported Donald Trump. Among the findings, 80 percent of Americans favor provisions: that allow young people to stay on their parents’ insurance plans until they are 26; that eliminate out-of-pocket costs for many preventive services and screenings; and that provide government subsidies to help low- and moderate-income people buy health insurance through the marketplaces established under the law. Perhaps surprisingly, the poll found that eight in 10 Americans also support the expansion of the Medicaid program for low-income people, a provision of the law to which many Republican politicians at both the state and national level have taken mighty exception. In fact, the only thing that the public seems to hate about the ACA is the mandate that everyone have health insurance or pay a tax penalty. That, of course, is key to making any system of guaranteed coverage work, something that both liberal and conservative insurance experts agree on, as Tribune News Service reported recently.
In all, nearly half of Americans said they want the law expanded or implemented as is, the Kaiser poll found, while 17 percent want it scaled back and just a quarter want it repealed, as Trump and Republican leaders in Congress have vowed to do as a top priority (albeit one without much in the way of specific proposals for replacement attached to it). Perhaps the election results can be explained in part by the fact that only 8 percent of voters said health care played a major role in their decision of whom to support.
Despite public support for the law, Republican leaders in Congress and the incoming administration are indeed planning to “repeal” Obamacare immediately next month, The New York Times reports. The quotation marks signify a big caveat: The effective date of repeal likely will be delayed, perhaps for as long as several years. Given that 20 million people have gained coverage under Obamacare since 2010 and the law has become entrenched among the nation’s health care providers, insurers, consumers and state governments, this “repeal and delay” strategy merely reflects both market and political reality. Immediate repeal could catastrophically destabilize a health care system that is already experiencing a difficult evolution, and it also might prove politically explosive. In fact, we’re betting that nothing much will be phased out before the 2018 mid-term elections.
The delay strategy has its own downside, of course, because uncertainty is a major problem for big health systems such as Dartmouth-Hitchcock as well as big insurance companies. As James Weinstein, chief executive of D-H told staff writer Rick Jurgens last month, in the absence of specific proposals, his organization has to proceed on its current path because, “I have no other road map to follow right now.” And Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute, told the Times that, “The idea that you can repeal the Affordable Care Act with a two-or three-year transition period and not create market chaos is a total fantasy. Insurers need to know the rules of the road in order to develop plans and set premiums.”
Maybe in light of all this, Republicans will ultimately decide to do what they should have done during the past six years, which is to work with Democrats to improve Obamacare, in particular to hold down costs, rather than dismantle it. Of course, if they do that now, they can rename it with the Trump brand, which, after all, might be the major point.
