Why Republicans Cant And Wont Repeal Obamacare
This article was originally posted on Real Clear Health on January 16, 2017.
Now that the Republicans control both the presidency and both houses of Congress, they must put up or shut up on their promise to repeal and replace Obamacare. Here is a flat-footed prediction: the effort will fail for three reasons. First, the Affordable Care Act has largely succeeded not failed, as president-elect Trump and other Republicans falsely allege. Second, it is impossible for the stated goals of repeal to be achieved. Finally, the political fallout from the consequences of partial or total repeal would be devastating. When it comes to casting votes, enough Republicans will conclude that repeal is a bad idea and will join Democrats to sustain the basic structure of the health reform law.
Second, the stated objectives of repealing Obamacare are mutually inconsistent. Three provisions comprise the core of Obamacare. First, rules barring insurance companies from refusing to sell insurance to people because of preexisting conditions or varying premiums based on those conditions. Second, a requirement that everyone carry health insurance who can afford it. And third, subsidies for those with moderate incomes to help make such insurance affordable. The law contains many other provisions as well, but these three are core.
Slashing Ads And Budgets
Funding for the “navigator” programme, under which trained individuals or organisations help people sign up for insurance through Obamacare, has dropped from $62.5m to $10m under President Trump.
His administration has also cut Obamacare advertising spending to $10m – a 90% reduction.
According to a November 2018 Kaiser Health poll, 61% of Americans aged 18 to 64 said they did not know about any enrolment deadlines.
Republicans Want To Get Rid Of Obamacare But Then What
President Trump has vowed to repeal the Affordable Care Act, but Sarah Kliff of Vox.com says it’s “an overreach” to say that Republicans have a plan for what comes next.
DAVE DAVIES, HOST:
This is FRESH AIR. I’m Dave Davies, in for Terry Gross. While President Trump clashed with some Republicans over a variety of issues in last year’s campaign, one thing they all seemed to agree on was the need to repeal the Affordable Care Act, known as Obamacare. Now that congressional Republicans have a willing president and the votes to scrap the health care law, they’re finding the task a little more complicated than it seemed. Republican lawmakers have a wide range of ideas about what they might replace Obamacare with. But a secret recording of a Republican policy meeting in Philadelphia revealed many are worried about the political cost of removing coverage from those who’ve come to count on it.
For some perspective on what’s happening in Washington and how it might affect our health care, we turn to Sarah Kliff, a senior policy correspondent at vox.com. Before joining Vox, Kliff covered health policy for The Washington Post and for POLITICO and Newsweek. She co-hosts a policy-oriented podcast for Vox called “The Weeds.” Kliff and co-host Ezra Klein recently interviewed President Obama about the debate over health care and the possible repeal of the Affordable Care Act. I spoke with Sarah Kliff Tuesday.
DAVIES: And where have we seen those pools before?
Board Of Governors Professor School Of Public Affairs & Administration
The Trump administrations efforts to sabotage the ACA and their consequences receive detailed attention in a recently released Brookings book, Trump, the Administrative Presidency, and Federalism. For present purposes, I highlight six major sabotage initiatives which emerged in the wake of congressional failure to repeal and replace the ACA.
1. Reduce outreach and opportunities for enrollment in the ACAs insurance exchanges. Established to offer health insurance to individuals and small business, the exchanges have provided coverage to some 10 million people annually. The Obama administration had vigorously promoted the ACA in part to attract healthy, younger people to the exchanges to help keep premiums down. The Trump administration sharply reduced support for advertising and exchange navigators while reducing the annual enrollment period to about half the number of days.
2. Cut ACA subsidies to insurance companies offering coverage on the exchanges. ACA proponents saw insurance company participation on the exchanges as central to fostering enrollee choice and to fueling competition that would lower premiums. The law therefore provided various subsidies to insurance companies to reduce their risks of losing money if they participated on the exchanges. The Trump administration joined congressional Republicans in reneging on these financial commitments.
Repealing Obamacare Is A Huge Tax Cut For The Rich
This did not play a major overt public role in the 2009-’10 debate about the law, but the Affordable Care Act’s financing rests on a remarkably progressive base. That means that, as the Tax Policy Center has shown, repealing it would shower moneyon a remarkably small number of remarkably wealthy Americans.
The two big relevant taxes, according to the TPC’s Howard Gleckman, are “a 0.9 percent payroll surtax on earnings and a 3.8 percent taxon net investment income for individuals with incomes exceeding $200,000.” That payroll tax hike hits a reasonably broad swath of affluent individuals, but in a relatively minor way. The 3.8 percent tax on net investment income , by contrast, is a pretty hefty tax, but one that falls overwhelmingly on the small number of people who have hundreds of thousands of dollars a year in investment income.
For the bottom 60 percent of the population that is, households earning less than about $67,000 a year repeal of the ACA would end up meaning an increase in taxes due to the loss of ACA tax credits.
But people in the top 1 percent of the income distribution those with incomes of over about $430,000 would see their taxes fall by an average of $25,000 a year.
The Acas Protections Changed Public Opinion In Its Favor Republicans Are Keeping Up
For more than a decade, the Affordable Care Act has been the Republican Partys nemesis. As it was first debated in Congress in 2009, when it was enacted in 2010 and through the next six years of implementation, Republican leaders rallied supporters by vociferously opposing it and calling for repeal. The Trump administration and states controlled by Republicans remain hostile to the ACA.
But the coronavirus pandemics fast-moving destruction has pushed Republicans to rely on Barack Obamas signature law to respond to the crisis, even taking action to strengthen it. The law, as written, requires that Americans who have recently lost jobs and insurance coverage to be permitted to enroll in its insurance marketplace, and they are doing so in swelling numbers. Meanwhile, Republicans recently backed that increased federal funding for a critical part of the ACA: Medicaid for lower-income people. And Trump administration regulators have used their authority to insist that insurance plans pay for coronavirus tests as an essential health benefit under the ACA a Republican target in the past.
Our research shows that this about-face cannot be explained by the pandemic alone. The partys rank-and-file and many other Americans have shifted to supporting the ACA and expanded government payments for health care. The pandemic is giving Republicans cover to follow changing public opinion.
Republicans have spent 10 years trying to kill the Affordable Care Act
Younger Americans Could Get Cheaper Plans
Obamacare was designed so that younger policyholders would help subsidize older ones. That would change under the Republican bill because it would allow insurers to charge older folks more.
This means that younger Americans would likely see their annual premiums go down. Enrollees ages 20 to 29 would save about $700 to $4,000 a year, on average,according to a study by the Milliman actuarial firm on behalf of the AARP Public Policy Institute.
Those under age 30 would also get a refundable tax credit of up to $2,000 to offset the cost of their premiums, as long as their income doesn’t exceed $215,000 for an individual.
The GOP tax credits would also likely be more generous than Obamacare’s subsidies for these folks. For example, a 27-year-old making $40,000 a year would receive $2,000 under the GOP plan, but only gets a $103 subsidy from Obamacare, on average, a Kaiser analysis found.
Also, the bill keeps the Obamacare provision that lets young adults up to age 26 stay on their parents’ insurance plan.
This Is Why Republicans Couldnt Make A Better Replacement
Republicans have made a lot of political hay out of pointing out that the plans available under the Affordable Care Act are, in many ways, disappointing. Unsubsidized premiums are higher than people would like. Deductibles and copayments are higher than people would like. The networks of available doctors are narrower than people would like.
These problems are all very real, and they all could be fixed.
They are not, however, problems that the American Health Care Act actually fixes. While Republicans have made several changes to the AHCA to cobble together a majority of House votes, the core of the bill remains the same: it offers stingier insurance to a narrower group of people.
This is because the AHCA does what Republicans want: it rolls back the ACA taxes. But under those circumstances, its simply not possible for the GOP to offer people the superior insurance coverage that it is promising.
The bill the House is voting on Thursday doesnt get rid of the ACAs tax credits to make it easier to buy health coverage, but it bases them on age, with younger people getting bigger credits, rather than income which means poorer Americans. especially elderly ones, will have a bigger tax burden and more difficulty affording the insurance they need.
Dont Like Obamacare It Was The Republicans Idea Says Liberal Democrat
Robert Reich served as Labor Secretary for President Bill Clinton.
While Republicans plot new ways to sabotage the Affordable Care Act, its easy to forget that for years theyve been arguing that any comprehensive health insurance system be designed exactly like the one that officially began October 1st, glitches and all, said Robert Reich, who served as President Bill Clintons Labor Secretary.
Reich says Democrats should have insisted on a single-payer system because it would have been cheaper, simpler, and more popular.
In a blog at The Huffington Post website, Reich that Republicans have long argued for a health care system based on private insurance and paid for with subsidies and a requirement that the young and healthy people sign up. Democrats, he says, wanted to model health care reform on Social Security and Medicare, and fund it through the payroll tax.
Reich says President Richard Nixon in 1974, proposed, in essence, todays Affordable Care Act. Thirty years later, then-Massachusetts Gov. Mitt Romney, another Republican, made Nixons plan the law in Massachusetts.
Reich adds: When todays Republicans rage against the individual mandate in the Affordable Care Act, its useful to recall this was their idea as well, as proposed in 1989 by Stuart M. Butler of the Heritage Foundation.
Reichs blog is entitled, The Democrats Version of Health Insurance Would Have Been Cheaper, Simpler, and More Popular
Background On The Health Care Repeal Lawsuit
From the beginning, the Trump administration and allied leaders in Congress and state governments have been committed to dismantling the ACA and the consumer protections it confers by any means possible. The Trump administration has repeatedly key provisions of the landmark law by executive actions and other more covert tactics, including removing essential consumer information from federal websites and defunding outreach and enrollment programs intended to expand coverage. After several failed attempts by President Donald Trumps legislative allies to repeal and replace the ACA, Congress passed a tax bill in late 2017 that zeroed out the individual mandate penalty.
After the tax bill became law, Texas and other states filed a federal lawsuit, claiming that because the mandate had no financial penalty, it made the rest of the law unconstitutional. U.S. District Court Judge Reed OConnor accepted this reasoning and held that the entire law must be struck down in what one legal expert called a partisan, activist ruling. On appeal, a 5th U.S. Circuit Court of Appeals panel also in December that, following the tax bills change to the law, the individual mandate is unconstitutional. The panel then remanded the case back to Judge OConnor to determine which parts of the ACA, if any, can remain given their decision. Since that ruling, the Supreme Court has to hear the case during its upcoming term, and, for now, the ACA remains the law of the land.
Obamacare: Has Trump Managed To Kill Off Affordable Care Act
The Trump administration has ramped up its attack on the Affordable Care Act by backing a federal judge’s decision to declare the entire law unconstitutional.
For now, Obamacare is still standing. Around 4.1 million Americans have signed up for new plans so far this year, according to government reports, down 12% from last year.
At a rally this week, Mr Trump again promised his supporters: “We are going to get rid of Obamacare.” But how much has he delivered on that pledge so far?
Efforts To Repeal The Affordable Care Act
|This article needs to be . The reason given is: Missing the May 2018 efforts. Please help update this article to reflect recent events or newly available information.|
This Is Also Why Republicans Might Drop Repeal
While mania for tax cuts is an important driver of the GOP push to repeal the Affordable Care Act, it might also ultimately be what leads them to abandon it. The healthcare debate has already taken more time than either Congress or the White House wanted and the bill hasnt even gotten to the Senate yet.
Meanwhile, many Republicans are itching to move on to their next priority: tax reform.
Republicans have a bunch of different tax plans floating around, but they all feature enormous tax cuts for wealthy households. Democrats will object, but they wont be able to stop the GOP from enacting a big tax cut. The only issue will be how large of an increase in the budget deficit do Republicans consider economically viable. Once thats decided, however, the tight linkage between the ACA and tax policy will be broken, since the entire rate structure will have already been rewritten in a way that makes the ACAs specific financing mechanism irrelevant.
No matter how the budget crunch gets resolved,however, the tax issue is the $500 billion elephant in the room. Its a key reason GOP leaders want repeal, a key reason theyve had trouble coming up with a popular replacement, and potentially a key reason theyll ultimately decide to move on to other matters. Talking about health care politics without talking about the revenue side misses an enormous part of the story.
Republican Views On Obamacare
The Republican Partys view on the Patient Protection and Affordable Care Actcommonly known as Obamacareis that its implementation was less about providing healthcare to millions, and more a result of power as the government sought to expand its reach over one sixth of the economy. The party claims that Obamacare has resulted in an attack on the Constitution of the United States because it requires U.S. citizens to purchase health insurance, and its impact on the health of the nation overall has been detrimental. The party is in agreement with the four Supreme Court justices who dissented in the ACA ruling. The justices stated, In our view, the entire Act before us is invalid in its entirety. As of 2012, the partys stance was that Obamacare was the result of outdated liberalism, and the latest in a series of attempts to impose upon the people of America a euro-style bureaucracy to micromanage all aspects of their lives. One of the partys biggest issues with Obamacare is its unpopularity among the peoplewhen polled on the subject, pluralities and even majorities often state they do not like the law.
Older Americans Could Have To Pay More
Enrollees in their 50s and early 60s benefited from Obamacare because insurers could only charge them three times more than younger policyholders. The bill would widen that band to five-to-one.
That would mean that adults ages 60 to 64 would see their annual premiums soar 22% to nearly $18,000, according to the Milliman study for the AARP. Those in their 50s would be hit with a 13% increase and pay an annual premium of $12,800.
Also, the GOP bill doesn’t provide them with as generous tax credits as Obamacare. A 60-year-old making $40,000 would get only $4,000 from the Republican plan, instead of an average subsidy of $6,750 from the Affordable Care Act, according the Kaiser study.
States could also receive waivers to allow insurers to charge older Americans even more than five times the premiums of the young.
Whats Dividing Republicans And Democrats On Healthcare Reform
Since the Affordable Care Act became law in 2010, Republicans have been determined to destroy it while Democrats insist its the countrys best chance at reforming healthcare to make it affordable and accessible. Both parties want reform, but the approach has been fundamentally different and for good reason. There are basic, core reasons why conservatives and liberals cant get on the same page when it comes to healthcare reform. Lets take a moment to dig into the details and figure out what is exactly keeping Republicans and Democrats from being able to find a middle ground on healthcare reform, so far.
Democrats want the federal government to legislate and administer healthcare while Republicans want private industry to helm the healthcare system with as minimal input from the federal government as possible.
Of course, there are always exceptions within each party because people arent one-dimensional. Moderates on both sides, for instance, would seek compromise wherever possible. But in general, these core ideological differences make healthcare reform particularly challenging, especially when one party holds more power. In 2010, Democrats passed the ACA without a single rightwing vote.
Repeal Of Obamacares Taxes Would Be A Huge Tax Cut For The Rich
This did not play a major overt public role in the 2009-10 debate about the law, but the Affordable Care Acts financing rests on a remarkably progressive base. That means that, as the Tax Policy Center has shown, repealing it would shower moneyon a remarkably small number of remarkably wealthy Americans.
The two big relevant taxes, according to the TPCs Howard Gleckman, are a 0.9 percent payroll surtax on earnings and a 3.8 percent tax on net investment income for individuals with incomes exceeding $200,000 . That payroll tax hike hits a reasonably broad swath of affluent individuals, but in a relatively minor way. The 3.8 percent tax on net investment income , by contrast, is a pretty hefty tax, but one that falls overwhelmingly on the small number of people who have hundreds of thousands of dollars a year in investment income.
For the bottom 60 percent of the population that is, households earning less than about $67,000 a year full repeal of the ACA would end up meaning an increase in taxes due to the loss of ACA tax credits.
But people in the top 1 percent of the income distribution those with incomes of over about $430,000 would see their taxes fall by an average of $25,000 a year.
Under the actual AHCA, Jared Kushner would actually pay even less in taxes. As a young person, Kushner would get a larger tax to buy insurance under the AHCA than he does now.
New Threats & Potential Affordable Care Act Changes For 2019
To date, the ACA has been challenged in front of the Supreme Court twice. Judges upheld the constitutionality of the ACA both times. But now, a new effort to strike down the act is making its way through our legal system. Two Republican Governors and 18 Republican state attorneys general, led by Texas, initiated the lawsuit.
The lawsuit, Texas v. Azar, alleges the individual mandate of the Affordable Care Act is unconstitutional now that TCJA set the penalty tax to $0. In December 2018, a Texas district court judge agreed with the plaintiffs. The judge also concluded that the intent of lawmakers was that the individual mandate was essential to the ACA, and as such couldnt be severed from the larger text. Therefore, the entire ACA was unconstitutional and repealing it was appropriate.
But the ruling hasnt gone into effect yet. The judge is allowing the status quo to remain until all the appeals have been heard. In efforts to combat the ruling, and since the current administration is refusing to defend the law in court, 21 Democratic state attorneys general and the U.S. House of Representatives filed an appeal to challenge the ruling. In July, the Fifth Circuit Court of Appeals in New Orleans heard arguments in favor of overturning the original ruling. The court hasnt yet reached a decision, and most believe this lawsuit will eventually make its way to the Supreme Court.
Republicans Are Still Trying To Repeal Obamacare Heres Why They Are Not Likely To Succeed
Conservatives are still trying to repeal the Affordable Care Act even after the Republican-majority Congress failed to overturn the law in 2017. A coalition of conservative groups intends to release a new plan this summer. The groups will reportedly propose ending the laws expansion of Medicaid and convert Medicaid funding into block grants to the states. And just last week the Trump administrations Justice Department argued in a legal filing that key provisions of the law its protections for persons with preexisting conditions are .
Why are Republicans still trying to undo the ACA? We argue in a forthcoming that the laws political vulnerabilities and Republican electoral dynamics drive conservative efforts to uproot it.
In the past, conservatives have thrown in the towel
As politicians and political scientists both know, the can never be taken for granted. Even so, the duration and intensity of conservative resistance to the ACA is historically unusual. The ACA is a moderate law, modeled on that Republicans once supported, such as insurance purchasing pools. Whats more, many red states refuse to accept the ACAs funding to expand Medicaid to more of their citizens such as , which has a large number of uninsured residents even though you would think they would want those federal benefits.
So why is the ACA still politically vulnerable?
The answer lies partly in the way the program was designed.
Is repeal likely?
The Health Care Repeal Lawsuit Could Strip Coverage From 23 Million Americans
Tomorrow, the Trump administration and 18 Republican governors and attorneys general will file their opening briefs with the Supreme Court in California v. Texasthe health care repeal lawsuit. The lawsuit, criticized across the political spectrum as a badly flawed case, threatens to upend the Affordable Care Act and strip 23.3 million Americans of their health coverage, according to new CAP analysisabout 3 million more than was forecast before the coronavirus pandemic. The anti-ACA agitators who initiated the health care repeal lawsuit, backed by the Trump administration, continue their attempts to dismantle the ACA, including its coverage expansions and consumer protections, amid the pandemic, during which comprehensive health coverage has never been more important. Millions of Americans who have lost their jobs and job-based insurance due to the current economic crisis are relying on the insurance options made possible by the ACA to keep themselves and their families covered.