It’s about time.
Those of us who have advocated for the repeal and replacement of Obamacare have been frustrated by the lack of a specific Republican strategy to actually achieve this. We could define our own individual wish lists, but that’s not the same as saying our party has its act together with an actual plan.
Well, there’s a plan now, but it will usher in a wave of new arguments.
The repeal is of the individual mandate, which was always the most noxious element of the so-called Affordable Care Act, which proved to have quite the opposite effect for millions of Americans.
That mandate was always a grotesque government overreach. The notion of requiring citizens to make a purchase is an affront to basic liberty. The ill wisdom of intentionally living uninsured does not change that fact.
But Obamacare needed premiums from every paying human being it could compel in order to fill the coffers with subsidies for others. Republicans apparently went to great pains to preserve the two elements of the law adored by large majorities: coverage for pre-existing conditions, which is understandable, and the capacity to keep our idle offspring on our policies until they are 26, which is ridiculous.
Refundable tax credits will free up money to buy better coverage in a freer marketplace, but TV screens will soon fill with people who will lament that the coverage they had yesterday may not exist in the same form tomorrow.
That’s exactly the point. Obamacare was always, from the starting blocks, unsustainable.
There was never going to be enough money from other people to pay the freight for tens of millions seeking subsidies. There is a cynical chorus that says this was the plan all along, that it would have enabled the Bernie Sanders wing of the Democratic party to say, “Hey, we tried,” and pivot to straight-up single-payer government health care.
There were obviously people who benefited from Obamacare, and they made their way dutifully to various town halls. But their stories do not outweigh the countless families burdened by skyrocketing premiums and deductibles. This is simple math. Free stuff paid for by other people is a road to economic ruin.
With the big reveal of a repeal plan, get ready for obsessions over Congressional Budget Office scoring, as if the CBO knows what the market effects will be when insurance companies can compete across state lines, and when doctor-patient relationships are freed from the ACA’s various government shackles. (Hint: it will be a joy to behold.)
At least the repeal also seeks to end the scam of federal funding for Planned Parenthood, which has every right to exist, but no right to tax dollars. Despite obtuse denials, such funding surely contributed to abortions. Any dollar a group takes in frees up another dollar it can then use for any purpose.
So as Democrats prepare to frame Republicans as actively rooting for Americans to get sick, a wide spectrum of GOP maneuvering will go on display, clouding a convincing retort.
Competing factions will throw sharp elbows on Medicaid restructuring, tensions will brew over whether the new measure is bold enough, and some voices may even have the courage to speak a harsh truth: that the promise of funding pre-existing conditions will make even the noblest GOP retool almost as unsustainable as Obamacare was.
Real reform means getting government’s hands off of our health care, even in the ways that many Americans have grown fond of. The good news is that statewide high-risk pools and state-by-state competition can provide hope and help in addressing any conditions, pre-existing or not.
But the journey to that clarity will not be smooth. With Barack Obama as president, countless repeal measures were dead on arrival.
Now that the path is cleared for a bill to actually see a presidential signature, the process of crafting that bill will be decidedly messy.
The writer is a Texas radio host and columnist for The Dallas Morning News.