No, Trump and Republicans Will Not ‘Fix’ Obamacare
Renewed Republican vows to “fix” the Affordable Care Act don’t even rise to the level of bad jokes.
When I joined the Wall Street Journal in 1991, a Republican pollster offered me an insight: the national political issue to watch was healthcare.
He proved prescient. Two years later, the issue dominated the early presidency of Bill Clinton, who declared healthcare “a right, not a privilege.” Fierce Republican opposition killed his health plan, but Democrats never gave up.
And neither have Republicans. Then and now, the GOP has clung to the same basic formula: you get whatever healthcare you can pay for.
That’s why renewed Republican vows to “fix” the Affordable Care Act don’t even rise to the level of bad jokes. They’re not trying to fix anything. They’re trying to conceal their unpopular views from Americans who need help, many of them MAGA loyalists.
The government shutdown highlighted this familiar Republican vulnerability. With strong public support, Democrats demanded extension of augmented Biden-era subsidies for insurance on Obamacare marketplaces. Republicans refused, defying the polls to follow their deeply-held beliefs about government and society.
What beliefs?
Republican lawmakers believe people with money usually deserve to have it, and those without it simply need to work harder. They view most government assistance as welfare for the undeserving. And by undeserving, they typically mean racial minorities – dogma that has survived the influx of millions of low-income whites into the GOP.
When Harry Truman proposed a national health program following World War II, Republicans killed it as “socialized medicine.” When Democrats worked to create Medicare in the 1960s, Ronald Reagan called it a threat to American freedom itself.
The pattern persists. The role of GOP healthcare “alternatives” is only to defeat Democratic plans.
When Clinton proposed universal government-directed health insurance, senior Republicans and the conservative Heritage Foundation countered with a plan requiring Americans to buy private plans subsidized by tax incentives. After stopping the Democratic president, they dropped the idea.
Fifteen years later, Barack Obama built the ACA around a similar “individual mandate” for the purchase of private plans, some of them subsidized.
One moderate GOP governor, Mitt Romney, had successfully implemented such a plan in the blue state of Massachusetts.
Republicans – including Romney, by then seeking his party’s nomination to oppose Obama – attacked the ACA ferociously. And the party never stopped attacking.
Obamacare tapped the market power of shared risk that all insurance depends upon. Mortgage lenders make borrowers buy homeowner policies even though few houses ever burn down; states make drivers buy auto policies even though few will have terrible accidents.
Requiring everyone to obtain coverage means that premiums from those fortunate enough never to face crippling expenses can protect the small number who do. That principle allowed the ACA to prohibit insurers from denying anyone coverage, even those with expensive pre-existing conditions.
It prevented insurers from jacking up premiums on beneficiaries who suffer new health problems. Young, healthy people paid more for comprehensive ACA insurance than for the bare-bones plans many had bought before – and many complained about that. But those higher premiums protected them against future medical misfortune, too.
With characteristic hysteria, Republicans warned the ACA would kill jobs and balloon healthcare spending. In fact, it did neither – even as it cut the proportion of Americans without health insurance in half.
From 2000 to 2009, national healthcare spending swelled as a share of the economy from 13.3% to 17.2%. Over the same span following passage of Obamacare in 2010, it barely ticked up to 17.6% – despite the swelling medical problems of an aging U.S. population.
National health spending stands at roughly 18% of the economy today. The unemployment rate, 4.3% in August, remains below levels of 10, 20, or 30 years ago.
Yes, premiums are rising for the 20 million Americans who buy health insurance from ACA exchanges. That’s before adding the increase caused by expiration of the augmented subsidies that Democrats want to extend but Republicans don’t.
But they’re rising as well for the 160 million who receive coverage (also government-subsidized) through employers. According to the Peterson-KFF Health System Tracker, similar factors are driving increases for both groups: hospital costs, growing use of expensive weight-loss medications, and the threat of Trump’s tariffs.
No matter how many times Republicans call Obamacare “a disaster,” the popularity of its protections prevent them from repealing it. Those protections cannot be replicated by old GOP stand-bys, such as state-level “high-risk” pools or health savings accounts purporting to turn patients into medical bargain hunters.
That leaves brain-dead bluster from the likes of Kentucky GOP Rep. James Comer, who derides the ACA’s “fake economy” that insures freeloaders at the expense of the hard-working few.
Kansas GOP Sen. Roger Marshall, a doctor who doesn’t understand insurance, cries “fraud” over the fact that “up to 40% of Obamacare enrollees never file a claim.”
That the Trump-era party does not seriously grapple with health policy is no accident. As ex-Biden White House economist Jared Bernstein wrote recently with only slight exaggeration: “Republicans focus entirely on stirring up partisan rage and legislating tax cuts favoring the rich.”
The president’s empty blather about how to replace Obamacare proves the point. Last week, Trump claimed sending government healthcare checks directly to Americans would lift their spirits and make them “feel like entrepreneurs.”
“Call it Trumpcare,” said the one-time proprietor of defunct Trump University, Trump Steaks, and Trump Vodka. It’s enough to make you sick.
John Harwood is the former chief Washington correspondent for CNBC and White House correspondent for CNN. He has interviewed every president from George H.W. Bush to Joe Biden. Sign up for ‘The Stakes with John Harwood’ to get all of his columns in your inbox.
The views expressed in this article are the author’s own and do not necessarily reflect those of Zeteo.
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I need an asterisk on this line: "They view most government assistance as welfare for the undeserving. "*
*unless that government assistance is a "subsidy"/payment, or tax credit for their business or a reduction in taxes due personally or for the business. Those are all earned and justified benefits from the federal government.
It’s hard for me to comprehend why Americans don’t demand universal healthcare similar to what exists in every other “developed” country. Why do we settle for a confusing system that is expensive and yields worse results?