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Don't expect Trump or the GOP to stop trying to kill Obamacare

Trump, GOP attempt Obamacare death by a thousand cuts
REUTERS/Jonathan Ernst
President Donald Trumps claims the plan is to let Obamacare collapse without doing anything to kill it so those who are adversely affected by the collapse can’t blame the Republicans.

The Affordable Care Act (aka Obamacare) was never perfect. Far from it. It’s too complicated, contains a hundred weird compromises and small payoffs to various industries and to reluctant senators to make passage possible. To really understand how it was supposed to work, you would have to sit still for a fairly long lecture. But it has done a lot more good than harm (at least according to my definitions of “good” and “harm.”)

It roughly cut in half the share of Americans who lacked health insurance, but if it had been allowed to work as designed, and if there had been a bipartisan commitment to make small fixes as problems became manifest, a lot more Americans would be covered by health insurance.

Zero Republicans voted for the Affordable Care Act, and they have spent seven years trying to get rid of it. Two parts of the strategy were to a) constantly emphasize and exaggerate its weaknesses without offering to help strengthen it; and b) ignore its benefits and work to undermine those benefits, and then use their successes in undermining its benefits to further exaggerate its weaknesses.

The current idea that is still alive [update: it went down in defeat early Friday morning] in the Senate is the so-called “skinny repeal” bill that would do away with the employer mandate (requiring large employers to offer insurance to its workers) and the individual mandate (requiring all adults to get insurance or pay a penalty).

Senate Majority Whip John Cornyn made explicit Thursday that these changes are not an attempt to improve the program, but to kill it. Here’s the Cornyn quote: 

The one thing that unifies our conference is the repeal of the individual mandate and the employer mandate. Those are two of Obamacare's biggest overreaches and are essential to Obamacare's functioning.

If you take away two things that are “essential to Obamacare’s functioning,” you have rendered it non-functioning. It would be hard to reconcile Cornyn’s admirable candor with President Donald Trump’s claim that the plan is to let Obamacare collapse without doing anything to kill it so those who are adversely affected by the collapse can’t blame the Republicans.

But the Republicans have been subjecting Obamacare to a death by a thousand cuts for years now.

If you want a great overview of the thousand cuts, you could not do better than this Tom Edsall column in the New York Times. I urge you to read it and to remember it every time a Republican tries to argue that the Affordable Care Act died of its own inherent shortcomings. Edsall is a treasure. And even if you think you know some of the thousand cuts Republicans have used to prevent the Affordable Care Act from functioning, you will discover some more in this column.

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Comments (19)

Down in Flames - Welcome to TRUMPCARE

The Republicans have demagogued the ACA for over seven years. Wouldn’t you think they would have a viable replacement plan by now? They have done all they can to sabotage the ACA mostly because of their total distain for President Obama. Everything they have done in the last seven months has been to reverse anything that President Obama did. Last night was the Republicans swan song. Senators McCain, Murkowski, and Collins voted no and the Skinny Repeal Bill failed to pass. They were unable to pass their last gasp, great hope of passing a bill. Republican senators stated they didn’t like the bill but voted for it anyway. I guess that makes sense to Republicans. It was President Trump’s main campaign promise. You have failed the President. A while back President Trump told the visiting Australian Prime Minister they had a better healthcare system than we do. Well, Republicans, according to the President, you have a model to follow if you want the US to have a model healthcare system too. Republicans, it is time to start demagoguing the Australian system because it doesn’t fit the Republican orthodoxy of do as little as you can for your constituents.

In January, when President Trump signed the executive order to REPEAL and REPLACE the ACA, the Republicans became the new owners of the so-called ACA disaster. Now they have the unenviable task of selling the despicable ACA as a great bill to the American public because it is Republican owned. According to the Republicans, the ACA is in a death spiral. What are they going to do to make it a positively wonderful functioning healthcare bill before the midterm elections? It should be easy because Republicans have total control of both houses of congress and the presidency. Remember, the President has promised the best healthcare bill ever. Welcome to TRUMPCARE! I think Leader McConnell, thought to be a genius politician by Republicans, has sold THE Republicans down a rabbit hole. Senators McCain, Murkowski, and Collins were the only Republican Senators that had the political courage to serve their constituents by voting no.

Kluge

The reason why the Affordable Care Act is such a kluge is that a simple and effective health care plan (a National Health Care or 'Single Payer' system) was not politically possible.

Hypocrisy is Stunning

Just saw this quote from Mitch McConnell. "Our friends on the other side decided early on they didn't want to engage with us in a serious way, a serious way to help those suffering under Obamacare." That this so-called leader would stand there and say this about Democrats after what he did for 8 years to undermine Obama should demonstrate to everyone how crass, heartless, and pathetic many Republicans are.

Providing actual health care for millions isn't even on the radar for them. It's basically about getting a win and and not stopping to diminish Obama in any way possible even though he's gone. Never mind that millions would be uninsured; that premiums were sure to rise; and that tax cuts for the rich would come at the expense of the poor and vulnerable. It was a campaign promise, by God. That these clowns couldn't deliver despite controlling everything and then blaming "our friends on the other side" is dark comedy at its best.

Ys, they're not going to give up; and, I think, they will eventually pass something but it still feels good to watch them whining today.

It Wasn't About Healthcare

It was always a tax cut bill.

I think the best thing the

I think the best thing the GOP can do is stop embaressing themselves and let Obamacare die its inevitable death.

They should have never even touched it in the first place, in my opinion. As it continues to run its course, and more folks suffer because of it, they would have rightly placed the blame solely on the Democrats.

Now that the GOP has soiled themselves and left their fingerprints on it, they will share the anger and, at least for GOP Senators, the consequences.

The only person that will emerge unscathed is Trump...go figure.

Not inevitable at all

Obamacare has never been as popular as it is today. The Republicans can't kill it because doing so would harm millions of people who depend on it.

Obama Care

Both parties need to give up on Obama Care. It was a bad idea from the start and the GOP or any party will be able to come up with anything that works. Both parties need to concentrate on legislation that does not include writing an insurance policy for the whole country, but rather brings back insurance company control with legislation to allow such things as pre-exisitng conditions.

Headslap*

You CANNOT write "legislation" to combat the practice of excluding pre-existing conditions without first "writing an insurance policy for the nation". It is not economically feasible in that you cannot expect an insurance company to write checks they cannot cover, healthy people MUST be insured to pay for the sick. Similarly, to expect government to fund care for the sick alone will create costs that will be politically not feasible to address. Go ask someone who is looking for high risk pools if they are willing to raise taxes to the tune of a trillion dollars to properly fund them, I expect you won't find any who agree. Any plan that separates the healthy from the sick is not interested in insurance at all, it's simply looking to divest from the notion that the cost for care for sickness or injury is something that should be shared by anyone, by any means, at all.

No

Since giving up Obamacare will mean that tens of millions of people will lose access to health care, neither party should give it up unless it's with something that actually improves it.

Privatization

So, you think that health is a commodity that should be controlled by private corporations?
And like most people who make the claim that the ACA 'doesn't work', you don't cite any facts, or produce any numbers beyond anecdotes in support of you claim.
Or should we believe that before the ACA no insurance company ever cancelled a policy, raised its price, or denied coverage.

Health insurance companies

Care only about profit, nothing else. They will avoid covering pre-existing conditions and any other requirements for coverage that damage their profits. Single payer is the only option to actually provide health care to everyone.

I appreciate all your fine articles, Eric.

And thank you for keeping the American public informed. You always do your research and it shows. If only our President would do some research before spouting off. If only . . .

The widespreads conservative

The widespreads conservative refusal to learn the basic principle of insurance is astounding at this date.

....The lowest cost insurance occurs when there is a large number of premium-paying people who can cover the costs of medical care for those who are currently making claims on the insurance.....

But hey, no.

And even worse:

From Trump's recent New York Times interview

.....So pre-existing conditions are a tough deal. Because you are basically saying from the moment the insurance, you’re 21 years old, you start working and you’re paying $12 a year for insurance, and by the time you’re 70, you get a nice plan. Here’s something where you walk up and say, “I want my insurance.” It’s a very tough deal, but it is something that we’re doing a good job of....

and then...he says the senators he met with at lunch “couldn’t believe it, how much I know about it. I know a lot about health care.”

What the heck is in his mind ???

Get a Life

Trump was confusing life insurance with medical insurance. I'm sure of it. It's the only way to read his quote and have it make even the slightest bit of sense.

And this is from the MAY 11th

And this is from the MAY 11th interview with The Economist:

... But we’re putting in $8bn and you’re going to have absolute coverage. You’re going to have absolute guaranteed coverage. You’re going to have it if you’re a person going in…don’t forget, this was not supposed to be the way insurance works. Insurance is, you’re 20 years old, you just graduated from college, and you start paying $15 a month for the rest of your life and by the time you’re 70, and you really need it, you’re still paying the same amount and that’s really insurance....

What does it say when a person holds the same mistaken belief about an important topic for months or years ?

Republican Hypocrisy

The Republicans have found out the hard way there needs to be facts behind their campaigning or they end up holding the bag as they now do with TRUMPCARE. Going into the vote Republican senators said if it didn’t get passed they would be the healthcare owners. Right on the mark. We can now expect destructive amendments added to non-related bills in hopes of getting some of their stuff signed in that they were not able to kill the ACA outright. They will continue to put their lucrative jobs and party above country and their constituents. I found McConnell’s concession speech typical Republican hypocrisy. Much of what he mentions was aided along by Republicans for the last seven plus years. McConnell said constituents have suffered a lot under the ACA such as skyrocketing costs, plummeting choices, and collapsing markets. He said the Republicans felt their constituents deserved better and yet over seven years later Republicans have proven they couldn’t come up with anything better. Hollow words and unsubstantiated claims are the words the Republicans offer for healthcare. In his expected impassionate and careless way President Trump is saying just let Trumpcare, formerly the ACA, implode. Well so much for care or compassion from the Republicans for the millions of Americans that need healthcare they will now be kicked off healthcare. End of story the President has washed is hands of healthcare hoping he won’t own the problem – too late – he owns it.

Once again…

…my irony meter has broken.

The ACA is based on a Republican plan, devised and promoted by GOP presidential candidate Mitt Romney, and based on recommendations from a variety of "conservative" organizations. In the ugly course of turning policy proposal into law, a host of compromises had to be made, many of them to suit the profitability of faux health insurance companies (any for-profit health insurance company is more interested in its profit than in your health) and other stake-holders in the health insurance industry.

Health care in this country is an exercise in capitalism, with everyone from the nurse to your doctor to the hospital to your insurer usually — not always, of course, but more often than not — looking after your health not because they care about you as a person, and want you to live a happy and fulfilled life, but because their job is to make money, whether for themselves or the shareholders in whatever company they happen to represent. Many physicians and physician practices are incorporated as LLCs precisely to shield themselves from losses they might sustain from making a life-threatening (or life-ending) mistake, not to mention the tax benefits of incorporation.

Paul Ryan and Mitch McConnell are not interested in the health of the American public, either in total or in detail. They're interested in supporting the interests of corporations toward which they are ideologically disposed, and which contribute substantially to their election campaigns because they've proven themselves a "friend" (others might use less complimentary terms) of health insurance companies, drug manufacturers, medical device manufacturers, and others who provide goods and services to the health care industry, and who expect to be well compensated for those goods and services.

The "freedom" that Republicans talk about in a health care context is largely the freedom to die earlier and more painfully than might otherwise be the case. When Paul Ryan talks about a repeal of the ACA giving people the "freedom" to choose their care, that freedom is based on numerous assumptions, most of which are false. There is no "free market" in health care. When was the last time you saw a price list prominently posted in your doctor's office, detailing the charges for office visits, minor surgery, major surgery, etc.? If you've been admitted to a hospital, where is the list, in the admitting room, showing you what various procedures cost?

"Choice" and "freedom" in this context require informed consumers, and much of American health care is based pretty blatantly on keeping consumers in the dark and oblivious to cost because it's "covered by insurance." People without insurance can tell you what their treatment cost because, if they couldn't pay the bill, collectors hounded them for the money. Of all the industrial nations on the planet, only in this country can someone go bankrupt paying for medical care.

Paul Ryan, Mitch McConnell, and their ideological brethren are simply trying to help you, your family, and all the rest of us, to reach that financial state sooner.

Or die trying.

Exactly!

The Heritage Foundation is to be respected for at least having the courage to still post the 1989 basis for GingrichCare, RomneyCare and ObamaCare:

Heritage 218

http://www.heritage.org/social-security/report/assuring-affordable-healt...

The GOP squandered, out of pure hate for a new President of a different color, the opportunity to say:

"Thanks Obama for using our ideas as the basis for your healthcare plans. Let's work together to get this right"

Imagine the possible outcomes we could have seen: No 8 year repeal and replace rants, evidence of a functioning legislative branch, a public that has some sense that government can work. And the last and best outcome: angry folks with axes and pitchforks would not have elected a pathological liar who promised that he, and only he, could fix everything that the right spent 8 years saying was wrong.

Of course this had ZERO chance of occurring because of leaders, who in moments of candor, describe sitting around the campfire at college keggars dreaming of someday taking basic necessities of life away from people in need.

Read the Edsall article Eric refers us to.

There you'll see detailed precisely how the GOP did not leave Obamacare alone to die or wither. They tried to kill it off, bit by little bit, by attacking it piecemeal.

Left alone, Obamacare would not have the high premiums and deductibles and cop-pays, or the lack of insurance companies offering coverage in certain areas. That's all the Republicans' work. Obamacare, with all its complications, works. But you can't take this part away, then that part away, and expect it to continue as devised.

So, for those who pay attention, health care's deficiencies in the U.S. (since we can't get single-payer universal health care), are the fault of the "governing" [cough!] party.