Let me suggest how America can progress to full UHC with minimal opposition from Republicans. It will take time, of course.
As I understand it, children in America are already beneficiaries of UHC, as are pensioners to some extent.
First, Veterans’ care is de-restricted. That is, veterans get UHC for life as part of the package deal for having served. Subject to an honourable discharge etc.
Later, care is extended to all those registered for selective service. “We must keep America’s population fighting fit” or some such guff. Since Americans register for SS around the time they leave school, there’s little or no gap. As a quid pro quo, women may be required to sign up for SS.
Later, coverage is extended from the end of SS to the pensionable age.
Later, pensioners get the full deal.
That will probably take two double terms, but it’s worth it.
Ok, so the ACA becomes effectively repealed, and the GOP trumpets “hey, we repealed it.” Then what?
With budgetary reconciliation, you can put money into or take money out of EXISTING federal programs, but at least the current set of rules doesn’t allow CREATING new programs, or even promulgating new laws that don’t have a direct and measurable effect on revenues, outlays, and/or deficits. So how do you get to the “replace” part of “repeal and replace”?
Or do you think the GOP will settle for “we repealed the ACA” with no replacement?
No, kids aren’t quite there yet. The CHIP program provides health insurance to kids whose families meet certain income guidelines, but if your family makes too much, too bad, so sad. Kids up to age 26 are eligible to remain on their parents’ coverage, but that requires their parents actually have coverage. It’s perfectly possible to be earning too much money to qualify your kids for the Children’s Health Insurance Program but not have employer-provided coverage, which means you are probably getting whatever coverage you might have on the soon-to-be-abolished ACA exchanges.
Pensioners have better coverage: everybody over 65 who earned sufficient work credits to qualify for Social Security (old age pension) also has sufficient credits to qualify for Medicare, and for instance spouses of SocSec-eligible pensioners usually qualify too.
Replacement will probably take 60 votes, or at least a willingness on Democrats’ part to not filibuster. Repeal will be voted on first, and if Corker, Collins, Paul, and Johnson get their way, the replacement right after. Repeal will pass, leaving ACA existing technically, but gutted. At that point, Democrats can filibuster the replacement and leave Americans with nothing and we’ll make them own that, or they can stand aside and let Republicans pass the replacement.
Yep. All the subsidies, all the money to the states for Medicaid expansion and the tax penalties for not purchasing coverage go away. (Yay! No mandate!)
We once did the same thing in my state so the result is easy to predict.
Either people step up and buy insurance policies to replace Medicaid and pay for the insurance themselves - or only the sick people buy insurance, prices spiral higher and higher and…
(I will leave the ending as an exercise for the reader)
That’s already what’s happening due to a mandate that only suckers comply with. There are apparently a lot of suckers out there, but not enough to prevent a slow death spiral.
You’ll make the “own” the fact that negative outcomes are because the GOP repealed the law that prevented them? Good luck on that. Especially when you basically own the government. It’s going to be very hard to blame the Democrats for anything in the next few years.
Frankly, Democrat voters–and any GOP voters who lose their insurance–are going to remember that you repealed it, and your voters…well, they’re the ones dumb enough to think that repeal was a good idea in the first place.
That, of course, would require the Republicans actually to HAVE a replacement that 50 senators, 218 representatives, and one president can agree to pass. Have you seen any such plan?
(Yeah, I know there are a few plans being tossed around, but I’ve seen nothing that anywhere close to a majority even of the GOP caucus agrees to support–have you seen any coalescing around a single plan? If not, that leaves the ACA gutted and the GOP standing around looking like the dog that finally caught the car.)
Yeah, but realize that the GOP is currently led by a man who thinks that paying taxes means you’re dumb. (Or at least that not paying them makes you smart).
It’s amazing how much more seriously the Republicans are taking this now that it’s for real and not for show. How many times did they “repeal” the ACA vs. how many times they are willing to REPEAL the ACA?
Good God, there’s a monumental amount of ignorance that permeates the GOP thinking in regards to ACA repeal. The party somehow thinks that it can go from Point A (i.e., the ACA status quo) to Point B (a post-ACA world) seamlessly and without any political firestorm in the interim. Such thinking is beyond ignorant and ignores basic fundamental realities.
Does anybody remember the massive fiasco that President Obama had to contend with in 2014 when a few thousand people had to upgrade to ACA-compliant policies (i.e., his famous ‘if you like your plan you can keep your plan’ misstatement)? Take the outrage that that incident sparked and then multiply it by, I dunno, twenty-fold, and then direct all of that anger at Donald and the congressional GOP. That is what will happen when 20 million people lose their health insurance and rightfully blame the Republicans for that loss.
What do I expect the Democrats to do in such a scenario? At the national level, I have no idea; healthcare is not going to magically vanish as an issue in a post-ACA world where costs continue to skyrocket and the uninsured rate becomes higher than it was in pre-ACA 2008. I will say that the potential Republican-induced collapse of the ACA really makes the argument for single payer much stronger than it was in 2009-10. The Democrats tried health reform the Republicans’ way - lest we forget that Obamacare WAS A REPUBLICAN IDEA - and if that cannot work, then obviously single payer, Medicare-for-all is the answer.
At the state level, I do think that ACA repeal will galvanize blue states into working like Hell to preserve their coverage gains. In a state like California, for example, in which the state economy is bigger than France, there is no reason why Covered California and some variant of Medi-Cal expansion could not find some way to continue. Similar moves would happen in New York, Massachusetts, Washington, and Oregon. The question then becomes: to what extent will national Republican policies try to preempt progressive state-level health reforms?
Bill Cassidy and Susan Collins have proposed a replacement:
Coming from Susan Collins it’s a big deal, since she’s a genuinely popular moderate from a blue state. Not sure of the details, but the general principle is sound: states can implement their own plans, or keep ACA if that’s what they want.
Of course ACA didn’t make the system dysfunctional. but it did actually increase costs due to the coverage mandates, and it utterly failed to bring young people into the system because the mandate was weak and unenforceable. So it solved a big problem(too many people uninsured) while introducing some new ones(higher costs, fewer choices).