The Republicans now own Obamacare…

… it’s on them if it fails.

Let me explain. When the Democrats passed the ACA (Obamacare) seven years ago, they were able to do it only because they held the Presidency and majorities in both houses of Congress. Shortly after that, Republicans regained the majority in the House and later the Senate, allowing them to obstruct further legislation by the Democrats. And additional legislation was definitely needed. The ACA was never intended to be the end of the story on health care. Complicated legislation often needs amending after it rolls out, and that was expected in this case. Obama himself even likened the law to a “starter home”… something we could build on.

And renovation is definitely needed. While millions of people have been helped by the law, many others still suffer from rising premiums and lack of choice among insurers. Even before gaining the White House, Republicans have had the opportunity to pass bipartisan legislation, but for the past seven years they’ve preferred to obstruct any effort to fix the law, instead favoring a goal of repealing it. Indeed, not only have they refused to fix the law, they’ve actively worked against it. Premium increases in 2017 are in large part because of Republican sabotage. The GOP succeeded in stripping funding from the ‘risk corridor’ reinsurance program that was meant to stabilize prices while new insurance pools were created. This caused many of the new insurance companies, including most of the non-profit insurance co-ops, to go out of business, reducing competition and choice on the health care exchanges and driving up rates among the remaining companies.

And now that they also have the Presidency, Republicans have even more power to sabotage the ACA. They’ve wasted no time in doing just that. One of Trump’s first actions after taking office was to pull the advertisements reminding people to sign up for insurance before the end of the 2017 enrollment period. Having as many people as possible sign up is important because larger risk pools makes for lower premiums. This is especially true with those last minute sign-ups because healthy people are more likely to procrastinate, and getting them on board will definitely improve the risk ratio, creating lower rates for everyone.  We know this from examining sign-up patterns from previous years.  But trump canceled the last week of advertising despite the fact that it was already paid for with no way of recouping the funds. The only reason to do it was to hurt enrollment (which it did).
And they’ve signaled that the sabotage will continue. The current health care bill being debated in Congress takes a wrecking ball to Obamacare, but even if they fail to pass that, they can do a lot of damage. Trump himself has said that, should the bill not pass, they would just ‘let Obamacare die’. But will it die a natural death, or will this be an assisted suicide? The GOP now controls Health and Human Services, the department that administers Obamacare. They have the power to do things like eliminate cost sharing subsidies that help make insurance affordable for lower income people. That will drive poor but healthy people from the insurance pool, further driving up rates for everyone else. Even the hint that they might do this could drive up rates as cautious insurance companies price the possibility into their future rates… and Republican leadership is already talking about doing it.
For seven years, the GOP has campaigned on repealing Obamacare. They now have the power to do it. They have the power to replace it with their own legislation or nothing at all. They can fix Obamacare or undermine it. It is all on them. They cannot just stand back and ‘let Obamacare die’ and hope the Democrats get all the blame. Democrats have no power to pass legislation right now. Republicans do. Whatever happens is on them. If they can’t get it together enough to actually deliver on their promises, then they need to get out of the way and let someone else do it (like maybe the party that passed Medicare, Medicaid, SCHIP, etc.. the party actually committed to helping people get health care).
It is now almost 19 months until the 2018 midterms. Republicans still have a window to deliver on their promises, but it won’t stay open forever.
The voters are watching.

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