“nobody knew that health care could be so complicated”

Trump said that today.  Honestly, I literally laughed out loud when I first came across that on twitter.  Yes, sadly, the American president is truly, laughably stupid and ignorant.  Of course, if you care about American health care (and a bunch of other stuff), that’s no laughing matter.

Is ACA repeal/replace dead?  No, but maybe ICU.  Chait’s short-take:

Last week, though, Chait wrote a terrific piece thoroughly outlining the incredibly politically difficult situation Republicans have left themselves in on health care.  You should read it.  But here’s the highlights:

A second, much deeper problem is that the beliefs Republican members of Congress do agree on are not shared by their voters at all. The Kaiser Family Foundation extensively interviewed Trump voters who have Obamacare to ask what features they would like changed about the law. Most of the voters like Medicaid, and dislike the fact that exchange plans have high deductibles. A KFF poll finds that 84 percent of Americans, and 69 percent of Republicans, want to keep the law’s Medicaid expansion. Meanwhile, the House Republican plan would slash funding for Medicaid and massively increase insurance deductibles. A belief in higher deductibles is the conservative movement’s central health-care policy conviction. Conservatives believe that forcing consumers to have “skin in the game” — giving them a financial incentive to use their bargaining power to hold down the costs of their own care — is the singular feature the health-care system most needs. [emphases mine]

Republicans were able to paper over this yawning chasm between what their base demands and what their elites are offering for the last eight years only because they have been able to avoid a specific alternative. Republicans attacked Obamacare for its high deductibles, and Trump promised a replacement that would give everybody better coverage for less money. But their proposals would do the opposite.Multiplesourcesreport that the House Republican replacement plan was supposed to come out this week, but was delayed after an initial analysis by the Congressional Budget Office yielded a horrific score. Their plan would cut the average subsidy level for a person buying insurance on the exchanges from $6,314 to $3,643, according to a preliminary calculation by the liberal Center for American Progress…

Obamacare did create some losers: The very rich pay much higher taxes, and young, healthy people have to pay higher premiums on the individual market. (The latter could one day become winners under Obamacare should they grow unhealthy or un-young.) They made a lot of noise — remember the media freak-out over the tiny number of people who lost their plans in the individual market? — but they were vastly outnumbered by the winners: millions of people who could now have access to insurance who once could not afford it.

The Republican plan, based on its skeletal outlines, has just the opposite effect. It would create very few winners and an enormous number of losers. One percenters would enjoy lower taxes, and healthy people could turn their Health Savings Accounts into lucrative tax shelters that don’t force them to cross-subsidize sicker people. On the flip side, though, millions of people who get insurance through work would be taxed to finance the GOP plan. Hospitals, doctors, and pharmaceutical makers would all lose business because millions of their customers would suddenly be unable to afford medications and treatments, having been forced onto skimpy, catastrophic plans.

Republicans may not have even realized until recently how deeply their ability to make political hay on Obamacare depended on not having power. They could posture against every inconvenient aspect of an industry nobody has ever liked, and promise all things to all people, with no responsibility to fulfill their grandiose promises. Now the dynamic has reversed

If Republicans somehow muster the partisan discipline to tear down Obamacare, as opposed to settling for minor changes, they will have to be willing to endure searing political pain.

And this is all happening before Republicans have published a detailed plan. That is the most amazing aspect of all. Obamacare repeal faces dire peril, and the most painful steps have yet to come.

Yep.  Complicated indeed.  Of course, there’s ways through these, but they all involve liberal policy solutions of more, not less, government involvement.  So, given their ideological commitments, Republicans are in a very complicated position indeed right now.

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

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