About that “replace”

Sure, there’s been plenty of other stuff to occupy our attention, but part of the reason we haven’t really heard much about replacing Obamacare is because Republicans are hopelessly gridlocked among themselves based on what they say they want to do, what they’ve promised, they ways they complain about the law, and their anti-government-damn-the-costs ideology.  Sarah Kliff offers a nice explanation:

Even when Democrats were split on how to expand coverage in 2009, they still were all working toward the same goal. They all agreed that whatever bill they came up with should lead to millions of Americans gaining coverage, particularly the type of people who had struggled to obtain coverage in the past (people who are older and sicker generally). There was a key principle at the heart of the party’s policymaking.

 But Republicans don’t seem to have this — it’s not clear what particular objective their policymaking is striving toward, aside from dismantling the Affordable Care Act. Sometimes their words and their plans point in opposite directions. [emphases mine]

You would think from the rhetoric of conservative legislators that the problem is what people have to pay out of pocket: that the deductibles under Obamacare are far too high.

“Many people who have insurance can’t even use it because they have $10,000 or higher deductibles,” House Majority Whip Steve Scalise told Fox News this weekend. Rep. Tom Price (R-GA) lamented in his confirmation hearing for Health and Human Services Secretary that “you have deductibles that have escalated to $6,000 to $12,000.”

 Or as President Trump put it to Sean Hannity last week: “The deductibles are so high that unless you get hit by a tractor, you will never be able to use it.”

The rhetoric is incredibly unified on this issue: Cost sharing under the health law is far too high. But the actual policies Republicans are developing move in the opposite direction. They don’t do anything like limit the size of deductibles in the marketplace, or cap out-of-pocket spending. Instead, most envision high-deductible health plans as an even more prominent part of the health care system

This is a debate we could be having about health care: about whether it would be better to make the overall cost of the law cheaper by moving toward high-deductible plans. You could envision a world in which Republicans say the government ought to take less of a role in health care and Americans have to become better shoppers as they face high-deductible plans.

But this isn’t what is happening — Republicans don’t seem, right now, to be working toward the goal of lowering deductibles or expanding coverage or anything else. They’re working toward the goal of repealing Obamacare, without a particularly clear vision of what exactly comes next. Until Republican rhetoric and policy come into line, it will be awfully hard for the party to come to any kind of consensus.

I really have no idea how this will turn out, but I do feel pretty confident that there will not have repeal and delay or just plain full repeal.  But how Republicans manage to make sense of the competing messages and policy priorities is a mystery to me.  And them.

Advertisements

About Steve Greene
Professor of Political Science at NC State http://faculty.chass.ncsu.edu/shgreene

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: