On Paul Ryan’s health care death march

Some updates on the efforts to keep repeal of the Affordable Care Act as quietly as possible so that House Speaker Paul Ryan doesn’t reveal his cowardice:

Ryan and his allies envision a quick, surgical strike on Obamacare soon after Donald Trump takes office, via what’s come to be known as a “repeal and delay” strategy. The idea is to eliminate Obamacare’s funding, using a special legislative procedure reserved for bills related to the budget, while leaving most of Obamacare’s coverage provisions in place for a year or two or maybe three. In theory, the more than 20 million people now relying on the program would hold onto insurance while Republicans craft their replacement scheme.

Even conservative experts doubt this gambit would work out so neatly. Insurers that tolerated early losses in Obamacare marketplaces in the hopes of realizing future profits aren’t going to stick around for a market that’s about to disappear ― particularly if the repeal bill also takes actions, such as eliminating the individual mandate, that would tilt the insurance customer base even more toward unhealthy people with high medical expenses. If enough carriers flee, a recent analysis from the Urban Institute predicted, millions of people would lose their health insurance in just the first year.

And why would Ryan and his allies want to move quickly? Parts of Obamacare are popular!

Those elements include not just protection for people with pre-existing conditions but also the availability of financial assistance for people who can’t afford coverage on their own ― which, in a recent Henry J. Kaiser Family Foundation poll, a whopping 80 percent of Americans said they support.

The same Kaiser Foundation poll found that roughly half of Americans want to keep Obamacare in place or expand what it does. Another 17 percent merely wants Congress to scale it back, while just over a quarter want full repeal ― and even that enthusiasm wanes when respondents learn that repeal might mean eroding the law’s consumer protections.

The Affordable Care act remains what Charles Pierce called “creaky, jerry-rigged contraption” that gets people “where they need to be” even if many in, say, Kentucky think their Medicaid expansions have nothing to do with the ACA. To my relief, the Democrats in the Senate have started to give Tom Price the side eye. Whether opposition is symbolic matters less than that the public watches the Democrats fight. That’s the point of symbolism.

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