Dealmaking or Sabotage? What’s the Future of Obamacare?

Will Donald Trump sabotage Obamacare by cutting off CSR subsidies for low-income workers?

A pair of prominent lawmakers urged President Trump on Sunday not to sabotage the Affordable Care Act, or Obamacare, in the wake of failed Republican efforts to scrap his predecessor’s signature legislative achievement.

….Sen. Susan Collins, the Maine Republican who steadfastly rejected a series of GOP healthcare measures last week, blamed the Trump administration for encouraging instability in the insurance markets….“I’m troubled by the uncertainty that has been created by the administration,” Collins said on NBC’s “Meet the Press.” She contested Trump’s characterization of the payments as an “insurance company bailout.”

“That’s not what it is,” she said, calling the reduction payments “vital assistance” to low-income Americans.

I’ve given up trying to predict what Trump will do. I can think of a dozen ideas that might flow through that squirrelly head of his on both sides of this question.

However, the Washington Post’s Amber Phillips has more courage—or foolhardiness—than me. Of four possible avenues for Republicans to take on health care, she ranks sabotage last. She ranks this as the most likely outcome:

Republicans start working with Democrats to make tweaks to Obamacare.

Surprise! The most likely option to revive Obamacare repeal isn’t to repeal it at all.

Republicans tried for months on their own, couldn’t do it, and now some key GOP lawmakers are advocating for the opposite approach….There’s a growing consensus among GOP members of Congress that working within the confines of Obamacare may be the only way to fix what they see as wrong with the law.

That’s a brave prediction, and I sure wouldn’t bet the ranch on it. That’s not because it doesn’t have some appeal. It plainly does. For one thing, a genuine compromise could get 60 votes, which means anything is fair game. You don’t have to worry about following all the arcane rules of reconciliation bills.

Nonetheless, it’s hard to see it happening. The Democratic asks are fairly easy to figure:

  • First, leave everything alone. Fund the CSR subsidies, enforce the individual mandate, don’t kill the taxes, etc.
  • Maybe reduce the max percentages families have to pay for health coverage at working-class incomes (for example, at 250 percent of the poverty level, make the cap 5 percent of income instead of 8 percent). Maybe create a high-risk reinsurance pool for extremely high-cost patients. Maybe a Medicaid buy-in for anyone who wants it.

It’s unlikely Republicans would agree to any of this, but if they did what could they ask for that wouldn’t be a deal-breaker for Democrats?

  • Change the age band to 5:1.
  • Some kind of cheap catastrophic coverage for the young.
  • Higher funding for HSAs.
  • Ease the rules for Medicaid experimentation by the states.

There’s more like that, but it seems unlikely to appeal to very many Republicans. What they really want is (a) lower taxes, (b) lower Medicaid spending, and (c) an end to the individual mandate. I suppose Democrats might agree to very modest versions of A and B, but certainly not C, which is vital to a functioning marketplace.

I dunno. It’s hard to see any kind of deal here, especially with Mitch McConnell so pissed off and Paul Ryan still under the spell of repealing everything. But I guess you never know.


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