Obamacare’s slow demise


To get a good sense of what direction the perpetually around-the-corner Republican replacement plan for the Affordable Care Act will look like, read Jonathan Cohn’s piece on new regulations proposed this week. These changes, in a broad sense, would make it easier for insurance companies to charge their customers more, provide fewer benefits, and further limit the number of health care providers covered in plans.

This might seem like an odd response to something Republicans have (accurately) criticized about what many Americans don’t like about their current health insurance plans—namely, higher costs and fewer options. In fact it seems to indicate an overall desire to address those concerns with proposals to increase costs, reduce coverage, and provide fewer alternatives for the sickest among us. The dissonance is something that’s been glaringly obvious to many who follow health care reform and these steps appear to confirm that the party of Trump is committed to seeing it through.

What they’re also committed to doing is eroding the law’s tentative control over the individual market’s stability. It seems fair to say that in the intermediate future, with a lack of a clear path forward produced by Republican indecisiveness, that repeal of the Affordable Care Act will take longer than the GOP is willing to publicly admit. While it comes across as mostly frustration between various factions on the right, it also provides an opportunity to help create a more amenable environment for conservative reform.

This is perhaps best exemplified through Trump administration’s quieter attempts to undermine the Affordable Care Act’s individual mandate. For that, read what Jeff Spross says:

If this were a homicide case, it wouldn’t be like stabbing a healthy person in the back. It would be more like taking someone you already know has a serious drinking problem and a wrecked liver out for a night of binge drinking where you pay for all the cocktails. It’s a craftier way to get away with murder, precisely because people might blame the victim for their own predicament.

New regulations and executive guidance will push, by inches, the scale towards insurers and (generally) towards those healthier, and wealthier, individuals previously priced out of the market. But a climate of increased uncertainty, coupled with these whispered tweaks, will foster an even more dysfunctional health insurance landscape that will benefit later Republican reform efforts. Which is to say, the greater the crisis, the better the opportunity to replace Obamacare with something worse.


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