Trumpcare: “If You Break It, You Own It.”

By Jill Zorn

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Last week Republicans headed to a meeting in Philadelphia, aiming to reach agreement on a plan to repeal and replace the Affordable Care Act (ACA), but it seems they left Philadelphia without any clear consensus on how to proceed.  In fact, a secret recording of the meeting that was sent to the media shows that some of them are actually getting nervous about the rush to repeal the ACA:

“We’d better be sure that we’re prepared to live with the market we’ve created” with repeal, Rep. Tom McClintock said, according to the Washington Post. “That’s going to be called Trumpcare. Republicans will own that lock, stock, and barrel, and we’ll be judged in the election less than two years away.” (See this Slate article)

As John Osborn points out in this Forbes article, McClintock’s remarks are an echo of, “Colin Powell’s infamous ‘Pottery Barn rule’ uttered in the lead-up to the invasion of Iraq: if you break it, you own it.”

Part of the disarray that Republicans find themselves in, is due to the mobilization of thousands of people across the country opposing repealing the ACA without a replacement plan ready to go.  All of the calls to congress, attendance at town hall meetings and demonstrations are clearly having an impact.  There are multiple national and local groups working on this resistance effort and it’s important to keep it up.

No Agreement on Goals

As Sarah Kliff points out in Vox, the Republicans lack clear policy goals, beyond dismantling the ACA.  As a result, their anti-ACA rhetoric often seems in conflict with their ACA replacement proposals.

For example, ACA critics from the right complain loudly about the high deductibles and co-pays that characterize plans available from the marketplaces, and point to them as part of the reason the ACA must be repealed.  But all Republican replacement proposals issued to-date rely to an even larger extent on health plans with high out-of-pocket costs, with less assistance with premiums.  And, if they are truly worried about affordability, why do  many of those same proposals eliminate the expansion of Medicaid to cover single adults all together?

The reality is that free market principles alone cannot maintain current coverage levels.  Here is the Forbes article, again:

“It is fascinating to observe the spectacle of politicians struggling to adhere to ideological principles that simply cannot be reconciled with the facts on the ground…Republicans despise federal government mandates and subsidies. But in their honest reflections, they know that Obamacare can’t be fixed without them and that their “replacement” plans will not meaningfully help those that cannot otherwise afford health insurance.”

Despite this lack of agreement, ACA repeal still seems to be very much on the table, and we face the very real possibility of a repeal vote without a clear replacement plan in sight.

Slow Motion Repeal

In the unlikely event that Republicans can’t quite bring themselves to pull the trigger on repeal, they are clearly implementing an alternative strategy of inaction and confusion that could have dire consequences for the ACA.

For example, insurers, like Connecticut-headquartered Aetna, continue to indicate that they view the ACA marketplaces as too risky.  The uncertainty inherent in a repeal-with-no-replace approach will only lead to greater marketplace instability and fewer insurers electing to participate in 2018 open enrollment, further weakening the program.

Another example of slow motion repeal is that the Trump administration significantly cut advertising spending in the crucial last four days of open enrollment.  Those ads were specifically aimed at younger, healthier people, needed to help stabilize the ACA risk pool.

Last week, the Trump administration issued an executive order regarding the ACA, which seems intentionally designed to sow confusion about the future of the program.

This statement by Sen. Patty Murray, reported in the February 1 edition of the on-line daily newsletter Politico Pulse, sums up the current situation:

“I want to be very clear: while my colleagues on the other side of the aisle do not have a plan, they are creating Trumpcare by sabotage.” ….”It is a broken system of chaos and uncertainty that will hurt, not help, families.”

So, even if the Republicans are not sure how to proceed, the administration is carrying out its own version of ACA repeal while millions of lives remain on the line.

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