How to kill Obamacare without “repeal” — Poison it

Republicans have figured out a way to kill Obamacare without “repealing” it: Poison it.

Republicans have asserted, hundreds of times, that they plan to kill Obamacare, aka ACA. But now that push has come to shove—now that they don’t have the safety net of a bill-vetoing Obama in the White House—it’s not as simple as they thought it would be. They’re getting pushback on their promise to “repeal,” – oh, wait—now it’s “repeal and replace” and/or “scale back.”

Even former Speaker of the House John Boehner, who was relentless in calling for Obamacare repeal, has now stated that it’s not going to happen.

According to an article in the New York Times:

…after weeks of local protests, boisterous town hall meetings and scores of quieter meetings between members of Congress and healthcare professionals, patients, caregivers and hospital managers in their districts, it is becoming increasingly likely that a consensus in the House will … hard to reach.

…Also, recent polls show increasing enthusiasm for the health law as Americans see its repeal on the horizon: a Pew Research Center poll of more than 1,500 adults…found that 54 percent approve of the ACA, while 43 percent disapprove. As recently as December, those numbers were evenly split.”



And now, if you look at the various proposals regarding the ACA that are circulating in Congress, it looks like the “repeal and replace” strategy is being, uh, repealed. In its place is a plan to “repair” the law [a creative and alliterative way to recast the emerging strategy to make it sound like it was always part of the plan. We can thank Republican spinmeister Frank Luntz for that one.]

But “repair” is deceptive. A closer look at the developing Republican plan for the ACA reveals that what they seem to be doing is to try to kill it softly, from within, while making it appear to the public that they’re keeping the parts of ACA that people want.

A very helpful sidebar in the New York Times breaks down the major aspects of ACA that Republicans are addressing, and what their plans seem to be regarding each.

According to the chart,

House Republicans’ plan to repeal and replace the Affordable Care Act, also known as Obamacare, would fundamentally change how health care is financed for people who do not have insurance through work.

The Republican plan keeps the goodies: Dependent coverage until 26; Pre-existing conditions policy; Restrictions on charging more for older Americans; Essential health benefits; and prohibitions on lifetime limits.

Retaining these provisions offers a smoke-screen designed to obscure the big changes that will, slowly and surely, create the death spiral that Republicans have been predicting since the law went into effect—and which they now plan to make a certainty through their own actions. Here’s how they’ll do it:

Repeal the individual mandate

ACA requires people who can afford it to obtain health insurance or face tax penalties. This part of the law was meant to keep insurance affordable for those who are older or sick. Under the developing House Republican plan, there would be no individual mandate, meaning that people will not have ot pay a penalty if they go without insurance. One possible impact, though, is that healthy people will be less likely to buy insurance, driving up prices for those who need it most, like older people and the sick.

Repeal the employer mandate

Under ACA, larger companies must provide affordable insurance to their employees or face financial penalties. Under the Republican plan, this mandate is out.

These are the poison pills of the “repair” plan. Taken together, these two moves would take millions of people out of the equation–mostly younger and healthier people. Fewer enrollees in these categories means a smaller risk pool. And a smaller risk pool means more pricey insurance for everyone. That will make for headlines Republicans will love and can use to say, “We told you so.” And that’s where the manufactured death spiral of ACA will begin.

But that’s not all Republicans are planning. Here’s more:

Changing subsidies

Under ACA, the federal government provides tax credits to middle-income Americans on a sliding scale according to income, to help offset the cost of premiums and deductibles.

The Republican plan changes the way subsidies will be distributed by using age, instead of income, as a way to calculate how much people will receive. This means that an older person with a six-figure salary would receive a larger tax credit than a middle-age person with lower income.

That’s another dose of poison designed to create resentment and to cause the health care law to fail.

So, if this is the plan, Republicans will be able to tell people that they listened and responded, and that they are “repairing” the ACA to improve “access” to health care. [Note the use of the term “access.” They are not promising actual health care, just the opportunity to get it, if you can.]  And it’s clear that they don’t intend to make it easier to buy access. They don’t mention that they intend to gut Medicaid and replace ACA subsidies with health-saving accounts—which are notoriously inadequate to cover the cost of insurance and actual health care.

What Republicans are hoping for, it appears, is to pretend they’re doing good, while injecting the “repaired” plan with a lethal dose of deadly legislative poison. And then they’ll blame the whole debacle on…Obama.