President-elect Trump announced this week that he will nominate Republican congressman and fervent Obamacare opponent Tom Price to be his secretary of health and human services, which seemingly makes the possibility of Obamacare being repealed that much more likely. After all, Price, who has actually drafted an Obamacare replacement bill, would be the ideal person to fulfill Trump and the GOP’s pledge to scrap President Obama’s signature legislative accomplishment.
But what remains unexplained is: Why?
Except for a very small and already advantaged group of Americans, nothing good will come from repealing Obamacare. Doing so will not lower health care costs. It will not cut premiums or reduce deductibles. It won’t ensure more Americans have insurance coverage. In fact, it would have the exact opposite effect and, in the process, lead to untold suffering for millions of Americans. It’s a pointless and partisan endeavor that turns the Hippocratic oath on its head: Rather than do no harm, it does plenty of harm.
Indeed, since Obamacare became the law of the land, in 2010, Republicans have consistently blamed the bill it for all the alleged failures of the American health care system. These criticisms are practically Orwellian in nature. After all, Obamacare has been anything but a failure. It has helped 20 million Americans receive health care coverage, reduced the number of uninsured by half, and cut the rate of health care inflation. Nonetheless, many Americans, particularly Republicans, believe that Obamacare has been a disaster, rather than one of the most successful pieces of social policy in decades.
That is not, of course, to say that Obamacare is without fault — but nothing that Republicans are proposing would make it better.
Take, for example, Representative Price’s replacement bill. It would get rid of Obamacare’s Medicaid expansion altogether. Most of the 15 million Americans who have enrolled in Medicaid since 2014 would either lose coverage or be forced to find new, likely prohibitively expensive, plans on the private market.
What about the fact that in some states Obamacare premiums continue to rise, along with deductibles? Getting rid of the bill’s mandate to buy insurance or cutting subsidies for Obamacare customers would almost certainly lead to even higher increases in the health care costs borne by consumers. Insurers would focus on selling to healthy customers and raise rates on everyone else, which would make coverage inaccessible for millions of Americans who currently are able to buy policies with the help of government subsidies.
According to Paul Starr, a professor of sociology and public affairs at Princeton University, three groups would actually benefit from repealing Obamcare: (1) individuals with incomes over $200,000, who would no longer have to pay the increase in the Medicare tax included in the law; (2) people who are currently paying a penalty for failing to enroll in any insurance plan, thereby violating the law’s individual mandate; and (3) young, healthy people who now make too much money to qualify for Obamacare subsidies but will see their rates go down when insurers can “cherry-pick whom to insure.”
Who will be hurt the most? Everyone else, but particularly those who aren’t rich, aren’t young, and aren’t healthy. And since Republicans are talking about winnowing down the benefits that Obamacare requires every health care plan to cover, even those who benefit today from a cheaper plan may find themselves with either higher premiums or limited access to coverage as they get older or sicker.
If Republicans really wanted to fix Obamacare’s problems, they could toughen the penalties for not buying insurance, increase the subsidies for health care consumers, and require insurers who currently sell in the individual market to participate in Obamacare exchanges. These steps would bring more healthy people into the Obamacare market, increase competition, improve the quality of plans offered, and lower costs. Expanding Medicare to those aged 55-64 would take the least healthy people out of the exchanges, which would further limit costs for everyone else.
We know none of this will happen, since Republicans have never shown any interest in improving health care options for Americans. Few seem bothered at the possibility of people losing coverage, destroying the individual market, increasing costs for consumers, and unleashing unnecessary suffering for millions of them. All of this might sound harsh, but that’s what they’ve already been doing by refusing to expand Medicaid in 19 red states, which has cost more than 6 million Americans the opportunity to enroll in the program. And rather than expanding Medicare, the most successful and popular health care program in the country, Price and other key Republicans want to privatize it.
Of course, taking away benefits is politically more difficult than never granting them, which makes the politics of Obamacare repeal that much more challenging. If only Republicans had the same concerns about the actual pain that would be caused by scrapping Obamacare as they do about the political pain to themselves.
In the end, however, the GOP’s obsession with repealing Obamacare is pure vindictiveness, consequences for the health of the American people be damned. Rather than talking about the politics of repealing Obamacare, Republicans dead-set on getting rid of the law should be forced to answer one simple question: Why are you doing this? Because repealing Obamacare has nothing to do with improving health care for the American people.
Michael A. Cohen’s column appears regularly in the Globe. Follow him on Twitter @speechboy71.