Our good friend Jonathan Bernstein makes an important point today at the Plum Line that most of us have just missed in all the hysteria about Obamacare implementation: whether the new law works or doesn’t, and whether Republicans gain control of the federal government in the next three years or don’t, the idea of just repealing the Affordable Care Act and trying to go back to the status quo ante is increasingly unfeasible:
[I]n practical terms, implementation of the health law (along with changes that happen over time no matter what the government does) mean that the system-that-was just is no more. Insurance plans have been cancelled, and new ones initiated. People have shifted coverage. Businesses have made new plans with ACA implementation in mind. That includes hospitals and doctors, and the rest of the health care industry.
No one is ever going to kick young adults off their parents’ insurance (or change the law so that insurance companies are allowed to do it). No one is going to bring back the various limitations in pre-ACA insurance policies. Some trimming of the new Medicaid rolls might be possible. But no one — no politician who has to face reelection, at least - is going to just toss all those people off their insurance with nothing to replace it.
Beyond all this is simply the Humpty Dumpty-ness of the situation: The old system has been slowly pushed off the wall for three years now, and by this point it’s really beyond repair, whatever the merits or politics of the situation.
Now I won’t go as far as Jonathan and say that the idea of repealing Obamacare is “dead.” His recitation of what no politician with a brain would do reminds me a lot of all those confident predictions (not by him, but by many others) that no state political leadership would be stupid or benighted or ideological enough to turn down the Medicaid expansion. And there’s also the possibility that Republicans, if they were in a position to do so, would repeal Obamacare and then quickly re-enact some of the easier and more popular provisions, like the provision allowing young adults to stay on their parents’ policies.
But yes, it’s true, the more Obamacare puts paid to the old system the harder it would be, mechanically, to resurrect it. So Republicans had better get it in gear in designing and agreeing upon a “replacement” agenda for health care, even if they know in their hearts it will be wildly unpopular in practice.
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