Why repeal Obamacare?

On December 9, 2015, the conservative American Enterprise Institute gathered a venerable panel of health policy experts, only to make hollow suggestions on how to repeal Obamacare.  This months old panel discussion is significant because similar proposals have made their way into the American Health Care Act (AHCA), meant to repeal and replace the Affordable Care Act (ACA).

Rather than repealing the law and replacing it with something 'better' AEI published a report essentially recreating a less generous version of the ACA.  For example, tax credits are offered to consumers to buy health insurance... which is already done through the federally facilitated marketplace.  Innovation is touted, but the same report proposes shutting down the Centers for Medicare & Medicaid Services’ Innovation Center.  The Innovation Center is well regarded across the healthcare industry, and is leading the way in reforming payments (in other words save money) to reward quality rather than quantity of care. 

The authors tout a private market approach, conveniently forgetting that most of the American health insurance market was already dominated by private industry.  This is the same market that withheld health insurance from those with pre-existing conditions, charged women extra for for being women, and did not cover mental illness, the world’s largest disability.  All the while, the authors claim they do not want to go back to what was there before, but do not acknowledge the progress that has been made.  All in all, the authors proposed repealing a law that has provided millions of Americans, including 1 million newly insured in 2015. 

The AHCA is a natural evolution of this kind of thinking.  Rather than acknowledging the progress that has been made and tackling the problems with the ACA, the AHCA seeks to throw baby out with the bath water.  Why? 

No program is perfect.  If the ACA were a state program it would have flaws.  If Obamacare were a private sector program, it would have flaws.  Lets hone in on the flaws, and propose solutions for those.  Co-payments are too high?  That's a specific critique that can be focused on.  So what is the solution?  Is the solution to repeal the law? Or could the law be adjusted and improved? 

Saying that states can regulate a policy of providing all Americans with health care is absurd.  If that is the case, then why weren't states doing this before the ACA?  Why is it that in most states the federal government provides the health insurance through the ACA federal exchange, even though all states had access to grants to start their own insurance exchanges? 

Saying that there should be no minimum standard for health coverage is also a cruel joke. Health insurance is heavily influenced politically.  In Massachusetts a consumer has to be at 230% of the federal poverty line (FPL) to get Medicaid.  In Texas a consumer needs to be at 42% of FPL to get Medicaid.  Why should geographic location within the US determine whether you will get care? 

Congress, and the public policy elite at think tanks and academia, need to target the problems within the ACA.  There is no sense in denying the progress made because the law has Obama’s name on it.  Politician work with political hyperbole for a living.  However, when a think tank like AEI takes an intellectually dishonest approach to the debate and provides credibility to the hyperbole, all Americans are harmed.  Most of AEI’s proposal was already covered by the ACA.  The AHCA has a basic framework similar to the ACA.  It should not be a shame in our culture to own up to such facts.