I'm surprised nobody has commented on this, but of course, the GOP has introduced its replacement for Obamacare. It is being almost universally panned. A good article discussing it by a staunch Obamacare critic who believes it's in some ways worse than Obamacare. It has a lot to hate in it almost regardless of your leanings. If you're a libertarian conservative, it largely leaves the government in a strong regulatory position in the insurance market (forces them to cover preexisting conditions, has price controls, etc.), reshuffles the mandate but doesn't really get rid of it, and continues to subsidize insurance, though it reshuffles that to make it less generous. If you're a liberal, you're not going to like it because it dramatically scales back the Medicaid expansion and will almost surely increase the number of uninsured people.
I really don't see how the bill passes. If you're a conservative from a safe district or state like Rand Paul, you have no reason to roll over for Paul Ryan or for Donald Trump and vote for this. Furthermore, if you're from a state that expanded Medicaid (as several Republicans are), you're taking a major risk supporting anything that kills off or weakens the expansion. And of course, it's highly unlikely that the bill gets a single Democratic vote. With some vicious arm twisting, I could see it barely getting through the House, but with a 2-seat majority in the Senate, I don't see how it passes there.
So why push this piece of garbage? There's no way in hell Paul Ryan actually likes it. However, there are problems. First, healthcare reform is a nasty issue to take on. A large number of people get screwed almost no matter what you do. That just goes with the territory.
Second, there is no political mandate for a free market-oriented/conservative reform. The GOP has defined itself by its opposition to Obamacare rather than by its support for a free market-oriented reform, and frankly, it didn't run on a free market-oriented reform. It ran on keeping the parts of Obamacare the public tends to like and replacing it with something - the specifics of which were never explained. Trump basically ran on what I might call "platitudes of bigliness" - "we'll cover everybody," "it'll be big and beautiful," etc. That doesn't provide any details, but it also doesn't suggest any kind of conservative plan. It suggests government involvement and guarantees. Effectively, we've conceded the argument that the government should largely control the financing of healthcare in the United States.
Third, the new Trump coalition wouldn't be receptive to conservative reform even if the case had been made. People forget that while Obamacare had plenty of losers, it had winners. If you're poor but weren't previously Medicaid eligible, have a pre-existing condition, are older but not yet Medicare eligible, Obamacare was mostly good for you. It provided you coverage where it didn't previously exist, doled out subsidies, and capped what insurance carriers could charge you. And here's the other problem - plenty of those people likely voted for Trump in key Rust Belt states. The Ryan plan is almost surely going to be worse for these people than Obamacare was. Medicaid will be less generous. The subsidies will be replaced by less generous tax credits that are allocated differently. The insurance carriers will be allowed to charge more. It'll be extremely easy for Democrats in those key states to say that the GOP made things worse for you rather than better. Will they screw it up? Perhaps, but under this plan, they'll at least get the opening they're looking for.
Last edited: Mar 13, 2017