What is going to happen to ObamaCare? That seems to be the question on the minds of most people I speak to these days. This year will have a huge impact on the answer to that question.
The 2016 presidential campaign will greatly influence the future of ObamaCare. It seems both parties are dissatisfied with ObamaCare – but for different reasons.
The Democrats still cling to their belief that ObamaCare is a huge success – yet even they want to change it. While touting the fact that millions more Americans now have health insurance, they conveniently ignore that they have fallen far short of universal coverage as President Obama promised. Although about ten million more people now have health insurance under ObamaCare, over 70% of these have Medicaid. There are still more than 30 million Americans without health insurance.
Hillary Clinton staunchly defends ObamaCare but admits that people are paying too much out of their own pocket for healthcare. She wants the government to pick up even more of the tab than they already do – by limiting the amount people must pay. Price controls for healthcare is another big government solution to a big government induced problem.
Republicans generally agree on the need to repeal ObamaCare with a replacement plan that strengthens patients’ freedom of choice and lowers costs by improving marketplace competition. Republican front-runner Donald Trump, however, has expressed his approval of single-payer healthcare like Canada and Scotland. If he or Hillary wins that may become a real possibility.
Insurance industry analyst, Robert Laszewski, was asked his opinions about the future of ObamaCare and responded in a recent blog. I find his comments confusing because on the one hand he doubts ObamaCare will be repealed, but on the other he says this:
“Bottom line: ObamaCare is not sustainable politically or financially in its current state if only because of how far short it is falling for those subsidy eligible people over 200% of the poverty level and for the 50% of the individual health insurance market that does not get a subsidy.”
“I look for lots of spin on the part of the administration and their supporters as the 2016 open enrollment comes to an end. But I don’t see a result that in the end really changes the game. During the election season democrats can’t admit ObamaCare is broken and Republicans can’t admit it won’t be repealed. The big question that will remain is: Who will fix ObamaCare?”
That is the big question.
The Democrats will try to fix ObamaCare by tweaking the margins of the law to make it more palatable to the American people. This will involve a series of government-mandated solutions like the price controls Hillary mentions or delays in the onerous provisions of the law, like the 2 year “Cadillac tax” delay just passed by Congress. The medical device tax has also been delayed.
But delays in the provisions of the law special interest groups detest won’t fix the fundamentals of a broken legislation. The law is filled with perverse incentives that artificially raise the cost of healthcare while reducing freedom of choice in picking your insurance policy, your doctor, and your hospital. We have a saying in surgery that fits this situation: “You can’t make a silk purse out of a sow’s ear.”
The law must be repealed and replaced with a completely different alternative; one that preserves the best parts of ObamaCare, such as coverage of pre-existing conditions and government subsidies for the impoverished, but without the onerous mandates that unnecessarily raise the costs for everyone – patients, doctors, insurers, and taxpayers.
Republicans must rally around an alternative that can be easily sold to the public during this election campaign. If they do, they can actually fix ObamaCare.
Politicians are generally wary of specifics in campaigns because their opponents will demagogue the issue with false claims, as President Obama did to John McCain when he proposed a gradual repeal of the tax exclusion on employer-provided health insurance. Then Obama did the exact same thing when he pushed through the Cadillac tax in ObamaCare.
But Republicans should not shy away from promoting the improvements they would make with an ObamaCare alternative. This has proven a winning election strategy in 2010 and 2014, and needs to be a central part of their platform in 2016.
Here are my predictions for the future of ObamaCare:
If Hillary Clinton, the presumed Democratic nominee, becomes president, we will have ObamaCare entrenched into the framework of our healthcare system forever. It may be modified, even converted to a single-payer system. But we will have government-controlled healthcare for the rest of my lifetime.
If Republicans regain the White House, real change is possible. If they control both houses of Congress, repeal and replacement with a conservative alternative will happen. If they fail to control Congress, ObamaCare will be modified in meaningful ways, but the burdens of an expensive system will persist and the quality of healthcare will decline, especially for those who cannot afford to pay for better care.