Thursday, October 27, 2016

Why An ObamaCare Fix Won’t Happen

By Jonathan S. Tobin
October 27, 2016

As the nation absorbs the news that ObamaCare premiums will undergo a massive increase (making it clear how badly misnamed the Affordable Care Act turned out to be), there’s a point that should be kept in mind: Both Donald Trump and Hillary Clinton believe that fixing it will be easy. Trump will do so by simply repealing and replacing it with some as yet unspecified market-based solution. Clinton says the law just needs some adjustments. Both are dreaming. One thing that you can count on not happening in 2017 is an ObamaCare fix.

Assuming that a President Trump would listen to House Speaker Paul Ryan’s ideas about reforming health care, there’s a chance the GOP might be able to implement some sort of scheme with which the country could live. But the chances of there being a President Trump who could sign an ObamaCare repeal and replace bill are dwindling (since Trump’s flaws have overshadowed the bad news for Democrats about ObamaCare), along with Republican hopes of retaining control of both chambers of Congress. A more realistic scenario is one in which President Hillary Clinton asks either a divided Congress or one still controlled by the GOP to clean up the mess that President Obama shoved down the country’s throat in 2010. In which case, a fix is just as unlikely.

Clinton is trying to play the bipartisan good-government card by saying that Republican leaders will be honor-bound to come to the table and work out a reasonable compromise after the election. Nothing short of a Republican sweep of the White House and Congress will make repeal possible. So if Clinton wins the presidency, the GOP dream of repealing ObamaCare will be over.

Though, even negotiations over a bipartisan set of fixes to the health-care law are almost certain to fail for the following reasons: First, a simple fix at the margins won’t work. The system is flawed in its conception and execution. There will never be enough healthy young people foolish enough to purchase insurance in the numbers that will pay for all of the sick and elderly who have benefited from the ACA. ObamaCare apologists say the skyrocketing rate hikes are no problem because they will be offset by government subsidies. But, as Bill Clinton helpfully pointed out earlier this month, millions of working and middle-class Americans make too much to get those subsidies. Even if you ignore that glaring flaw, what Democrats are really saying when they use the word “fix” is that they will simply demand that the government pour increasingly vast sums into the program to ensure that this new entitlement stays afloat.

Do liberals expect re-elected Republicans, especially if they have a majority, to acquiesce in a fix that simply means creating a new taxpayer-funded sinkhole? Even if all Republicans were infused with a pure spirit of bipartisanship this would be a bridge too far for almost all of them. Nothing short of a willingness on the part of Democrats to rethink the entire structure of the ACA would induce enough GOP members to allocate more funds to save it, and we know that won’t happen.

Second, even if there will be some in the GOP caucus who think negotiating about ObamaCare’s future is the right thing to do, the party’s current dynamic won’t let the leadership get away with it. While liberals will denounce this as a sign of extremism, the fact is that after six years of fighting the concept, the spectacle of GOP members not merely admitting defeat but being willing to further sink the country into debt to pay for a health-care plan is unthinkable. A restive base of Trump supporters who will be wrongly blaming the party establishment for their hero’s defeat will also render any movement toward Clinton on the issue impossible.

Third, most Republicans as well as most Democrats (if they were being honest) know that a marginal fix isn’t the liberal objective. Having gone this far toward their goal of universal health care with Obama’s flawed scheme, left-wing Democrats won’t be satisfied with merely a blank check to keep ObamaCare temporarily solvent or even to fund more subsidies. They want a government single-payer option and will continue to push Clinton to move in that direction. That pressure will increase as the ACA’s troubles mount and more Americans continue to suffer from its high costs and poor coverage.

Unless the Democrats take both Houses of Congress along with the White House (in which case, the debate about single payer will start sooner rather than later), what we’re likely to see is even more political combat over the ObamaCare disaster in the next four years. Obama’s legacy will not only be a failed plan but the continued partisan strife he first fomented in putting that plan into place.

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