Obamacare is dying, but it’s also winning

The Observer editorial board

Rep. Tom Price, who is Donald Trump’s choice for Health and Human Services secretary, is a fierce opponent of Obamacare.
Rep. Tom Price, who is Donald Trump’s choice for Health and Human Services secretary, is a fierce opponent of Obamacare. Bloomberg

Look at what people are starting to miss already: Obamacare.

Insurers are expressing nervousness about its impending repeal. Hospitals are more than nervous; they say it’ll be a financial calamity. Most Americans say they don’t want to see it go, either.

But go it will. Republicans, including President-elect Donald Trump, say that repealing the Affordable Care Act is at or near the top of their legislative priorities. After all, it’s what Republicans have wanted – and what they’ve promised their supporters – for years.

But doing the deed is proving to be more difficult, logistically and politically, than many in the GOP imagined.

Here’s why: After six years of vowing to repeal and replace the Affordable Care Act, Republicans still haven’t figured out the second part. In large part, that’s because they can’t come up with an alternative that provides the benefits Americans have grown fond of under Obamacare without the loss of health care coverage for tens of millions.

So instead of killing Obamacare now, Republicans coalesced around a plan this week that would keep the ACA around two to three more years, with hopes that they can settle on something new by 2018.

The repeal-but-delay approach has its own complications. Insurers, some of whom were already leaving the ACA exchanges, could ditch Obamacare en masse instead of dealing with the uncertainty of a dying law. To head that exodus off, Republicans may promise to cover insurers’ losses on the exchanges – the same kind of “bailout” the GOP decried when Democrats tried to help insurers in recent years.

Insurers also are worried about how a new plan can keep the ACA benefits that Americans (and President-elect Trump) like – such as coverage for pre-existing medical conditions – and make the bottom line work. Republicans have suggested going back to the old way of doing things, such as high-risk pools run by states – but insurers aren’t interested in returning to that chronically underfunded option.

As it turns out, Americans aren’t terribly interested in the old way, either. A poll released by the Kaiser Foundation last week showed that more people wanted Obamacare to survive or be expanded (49 percent) than wanted it repealed (26 percent) or scaled back (17 percent.)

That’s left Republicans contemplating fundamental questions they’ve previously been reluctant to consider, such as how to get or keep healthy people in the insurance pool so that they can pay the freight for the sick. One GOP possibility: A concept called “continuous coverage,” which says pre-existing conditions must be covered so long as a person hasn’t let coverage lapse.

None of which means that Obamacare won’t be repealed. It will be, and there’s still a real danger that the ACA’s replacement will result in millions of Americans losing insurance.

But Republicans are acknowledging now that the conversation about health insurance has changed. Americans now expect a system that provides Obamacare’s core benefits – and one that doesn’t leave the sick or poor out in the cold.

In just six years, the Affordable Care Act has changed that conversation and those expectations. Obamacare may be dying, but in some ways, it’s already won.