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.