The Affordable Care Act (also known as Obamacare) has been under attack since its inception. Republicans, especially, have attacked the insurance program, and now that they have a majority in both the House and Senate as well as a Republican president, they are threatening to dismantle the program and replace it.
For all its flaws, bumbled launch, and absence of Republican support, Obamacare has provided health insurance to some 20 million Americans who didn’t have it before.
Last week the Senate took a big step to dismantle the Affordable Care Act by passing a budget blueprint that will make it easy for Congress to repeal the act.
Prior to passage of the Affordable Care Act, members of Congress and their staffs, among other Capital Hill employees, were covered by the Federal Employees Health Benefits Program, which provided congressmen and senators with good, inexpensive insurance. Under the more than 300 insurance plans offered by the program no one could be refused, or charged more, for a pre-existing condition, and dependents under 26 were covered. Sound familiar? These are some of the same attractive parts of the Affordable Care Act.
Once the Affordable Care Act was passed, members of Congress and their official staff were required to obtain coverage by health plans created under that program or coverage offered via an Affordable Insurance Exchange. In other words, the more comfortable choices that were available for more than 50 years were suddenly transferred to Obamacare.
It follows that if the Affordable Care Act is repealed, members of Congress would be able to return to the federal plan that they, like millions of federal employees, were so fond of. However, those 20 million Americans who now have insurance under Obamacare won’t be able to do that.
President Donald Trump and the Republicans in Congress say they will replace the Affordable Care Act with something. They just haven’t been clear about what that replacement will look like.
President Trump has laid down a standard for replacing the Affordable Care Act — even broader coverage at lower cost — that no Republican plan can meet, phased in or not.
“We’re going to have insurance for everybody,” Trump told The Washington Post in an interview. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen.”
But Trump did not reveal how he would pull that off, saying he’s waiting for his Secretary of Health, Tom Price, to be confirmed. Such is Trump’s way: Promise and delay. Nobody should expect to find a gift from Trump anytime soon.
Trump has said that he’s opposed to the law’s mandate that everybody buy health insurance but that he wants to keep the part of the law that prohibits insurance companies from rejecting people with pre-existing conditions. But he hasn’t explained how he expects insurance companies to take on the burden of insuring those with pre-existing conditions if those companies aren’t also getting premiums from people with no history of illness. The mandate isn’t an end-goal of the Affordable Care Act; preventing sick people from being denied insurance is. And the Republicans must take care that whatever replacement plan they come up with not return us to the dark days of the recent past where getting sick could bring a cancellation notice from one’s insurance company.
Of course, the significance of pre-existing conditions is diminished for people who get insurance through their employer or through a program such as Medicaid. But it’s a real concern for the person who is self-employed or who is between jobs or who gets divorced from a spouse who had a policy that covered them both.
As opposed as many Republicans were to President Obama and the Affordable Care Act, now that they are completely in charge, they must let pragmatism be their guide. Many Americans never had insurance before the Affordable Care Act. Such progress ought not be reversed.
Republicans now control the new Congress; let’s hope they have ideas. But first, they should follow the basic health care oath: Do no harm.