Obamacare is Effectively Repealed. Where Do We Go from Here?

Prior to the
Obamacare mandate, whenever a non-insured person would be rushed to the
hospital for an emergency, it was the people who already had insurance who paid
for that hospital visit through the increased costs of medical services and
premiums. With the enactment of the penalty, those non-insured people would be paying something into the system and thus help lower the costs. The penalty also incentivized young healthy people, who customarily
did not buy health insurance, to do so. Thereby increasing the number of
healthy people contributing to the marketplace, and if not lowering the cost,
certainly slowing the growth of health insurance premiums. The Obamacare mandate was a crucial and essential part of the overall Affordable Care Act.
After it's repeal, the CBO is reporting that by the year 2025 the total number of uninsured Americans will hit 41
million, just 5 million less than the 2008 pre-ACA uninsured level. With that level of uninsured Americans, we are basically back to where we were in 2008 and it is fair to say that the Affordable Care Act is effectively repealed.
Where do we go from here?
The first step is to identify where the Affordable Care Act went
wrong and why it was so easily repealed. There are several legitimate reasons why Obamacare was so unpopular, why
GOP attacks were so effective and why it was subject to repeal so quickly after
its enactment.
First and foremost, the idea that a big part of the Affordable
Care Act involves funneling billions of dollars to ‘for-profit’ insurance
companies in order to incentivize them to provide lower cost health insurance
programs was never going to be popular. Politically speaking, it is terrible optics in this age of surging populism and ripe for criticism.
The mandate, which is an absolutely necessary element of the ACA, was politically toxic. Simply, the political language to force someone to buy insurance that a large corporation was going to profit off of is not good politics.
Key elements of the ACA were ‘means tested’. A means test is a determination of whether a
family is eligible for government assistance based upon whether that family
possesses the means to do without that help. For what it’s worth, means testing
is also politically toxic. The reason means testing is so unpopular, versus
universal programs such as Social Security, is because the benefits are denied
to a large number of people who are forced to pay for them. Additionally, means
testing benefits hurts people who are just above the cut off point.
Universal benefits, such as Social Security create a sense of
solidarity, shared understanding and thus make those programs much harder to
repeal. Means tested benefits create animosity, division, misunderstanding and
an “us versus them” dynamic.
When the Democratic party retakes control of the levers of power,
they could reinstate the repealed provisions of the Affordable Care Act, but
that would be futile. Due the unpopular and politically toxic parts of the program, it is not possible
that the ACA can survive the assaults from the right. The Democrats must change
their party platform, move away from the market based
insurance system and adopt a ‘Medicare-For-All’ single payer system. The pragmatic incremental approach to advancing universal healthcare coverage proved to be a failure. The Democratic party needs to adopt big bold progressive ideas to further differentiate itself from the rotten Republican party. Only a defensible universal program will be able to withstand the assault from the Republican Party.
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