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June 06, 2014 1:24 PM What Does It Mean to “Fix” Obamacare?

By Ed Kilgore

It’s well known that many Democratic candidates for federal office this year, especially in red states, have adopted the line that they want to “fix” rather than “repeal” Obamacare. But now that early fears about Obamacare’s “failure” have abated, and millions of people are actually benefitting from its provisions, Republicans are beginning to take the same line, though sometimes implicitly rather than explicitly.

This alarms conservative columnist Ramesh Ponnuru, not just because it represents a breech in discipline (and the sort of thing that leads Tea Folk to fear GOP pols are squishes), but because some types of Obamacare “fixes” don’t make a whole lot of substantive sense. He singles out Oregon Republican Senate nominee Monica Wehby as an example:

On her campaign website, Wehby, a surgeon, runs through a list of changes she wants made to the president’s health-care overhaul. She would, among other things, get rid of the individual mandate to buy health insurance, offer more catastrophic insurance options on the exchanges and make it easier for people to buy insurance across state lines.
But she also wants to keep several Affordable Care Act provisions, including the one that bans insurers from discriminating against people with pre-existing health conditions.

After a brief analysis of the consequences of repealing the individual mandate, Ponnuru notes:

The rest of her plan works at cross-purposes with itself. Let people buy catastrophic options, and healthier people will buy them. The more extensive plans that sick people want will have to get more expensive or go off the market.

The real problem with Wehby’s position is that she is basically for repealing the parts of Obamacare that don’t poll well, and maintaining those that do, regardless of the incoherent mess created by the provisions that pass the popularity test.

Is Ponnuru’s complaint applicable to Democrats who talk about “fixing” Obamacare as well? It depends. The “fix” positioning spread among Democrats during the terrible rollout of healthcare.gov, and the initial panic of people with cancelled individual health plans. Much of the “fixing” we heard about then involved “fixing” the enrollment process and perhaps giving more leeway for existing policyholders to hang onto their insurance. These were not by and large attacks on the basic structure of the law, and many of the “fixes” have actually already happened. But some Democrats seem to be pointing towards a different structure without getting as specific as Wehby about what to leave in and what to leave out.

What Ponnuru wants Republicans to do is to bite the bullet and embrace an alternative that fits together more coherently but that might be no more popular than Obamacare—i.e., one that puts people with pre-existing condition in their own little risk pool ghetto where people who have lost life’s lottery would be consigned to bad insurance at high prices, and expects everyone else to pay a lot more out-of-pocket for health expenses. (In all alternative GOP plans, needless to say, beneficiaries of the Medicaid expansion would be totally out of luck, along with many existing recipients who would be exposed to “reforms” designed to force or allow states radically cut back eligibility). While there is an intellectual elegance to such “alternatives,” life for poor and unhealthy Americans would be far better under Obamacare, or even Wehbycare and other schemes to “fix” the law.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

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