Philip Klein:
Many problems predicted by Obamacare opponents are becoming reality, but Republicans are not ready to deal with the consequences should one of their candidates win the White House.
To be clear, any fantasies about Obamacare “collapsing under its own weight” and thus relieving Republicans of the responsibility of governing are just that — pipe dreams. Whatever the problems facing Obamacare, the law won’t simply go away on its own. By the time the next president takes office, it will still be covering millions of Americans and imposing a raft of regulations on individuals and businesses.
That said, there are very real and serious problems facing the law. Now that insurance companies have had a chance to assess medical claims being filed from those who signed up for Obamacare, it’s become clear that the pool of enrollees is costlier than expected. Simply put, insurers aren’t signing up enough young and healthy individuals to offset the cost of covering older and sicker enrollees. And the administration has slashed its enrollment projections for 2016.
Insurers have already been forced to either hike premiums or limit choices of doctors and hospitals in their networks. Things promise to get worse after 2016, when several provisions of the law intended to absorb risk taken on by insurers expire. Originally, these measures to mitigate risk were to serve as a form of training wheels in the first three years of Obamacare’s implementation, the hope being that by 2017, the health insurance exchanges would be established enough to thrive on their own. But that is looking less and less likely. Without a federal backstop or an unexpected improvement in enrollment among the younger and healthier population, insurers will have to decide whether to exit the Obamacare market or hike rates even further. More exits by insurers will mean fewer choices and even higher premiums.
That will be the environment facing the new president in January 2017, meaning that if a Republican is elected, there could be a real opportunity to reopen the law. But the problem is, Republicans have yet to resolve their very real policy differences.
Chris Jacobs, a healthcare policy veteran of Jim DeMint’s Senate office, the Heritage Foundation, and Gov. Bobby Jindal’s America Next policy shop has been involved in the GOP health policy throughout the Obamacare era. In a recent conversation with theWashington Examiner, Jacobs, now a senior editor of Conservative Review, predicted an utter mess facing the next Republican president on healthcare because of the failure to litigate policy differences during the presidential campaign.
As Senate Republicans grapple with how far to go on a bill to repeal parts of Obamacare they hope to send to Obama’s desk by the end of the year, the healthcare issue has been largely absent from the GOP presidential race. Thus, the very real and very important argument about balancing free market goals with political practicality has been deferred.
On the surface, there seems to be a growing consensus among Republicans when it comes to crafting an Obamacare alternative. Several plans introduced by Republicans in Congress have significant overlap with the presidential proposals unveiled by Gov. Scott Walker when he was running, and more recently, Jeb Bush. Those plans would generally repeal Obamacare and provide a tax credit to individuals to help them purchase insurance instead.
But many conservatives object to the idea on the grounds that a tax credit in effect is really another term for more government spending.
Other proposals, including ones introduced by Jindal and the House Republican Study Committee, instead rely on giving a standard tax deduction to individuals for purchasing health insurance. But fans of the tax credit argue that this approach wouldn’t do much to help those with little or no tax burden against which to deduct, meaning that it wouldn’t be competitive enough on coverage to be a politically viable alternative to Obamacare.
