There is a growing realization on the right and left and, most acutely, from the insurers and health care providers that repealing Obamacare with the promise that something better will come along at some later date would be a policy and political disaster. Insurers would accelerate their withdrawal from exchanges, heightening the demise of the exchanges. Individuals would lose coverage, health-care horror stories would spread like wildfire and the GOP would pay an awful price with the very people they are supposed to be helping. There are two alternatives: 1.) Repeal and replace all at once or 2.) Grandfather everyone.
The first is the most logical. Republicans say they have a better way (literally called A Better Way) to provide health-care insurance. They’ve had six years to come up with something. Let’s see it and find out if they can pass it. Truth be told, they don’t have agreement among themselves let alone with Democrats. In that sense the “repeal and replace” promise is fraudulent. If they cannot replace it, don’t promise to repeal it.
The next alternative (with modifications we’d suggest) comes from conservative health-care guru James Capretta of the American Enterprise Institute:
“The GOP should take the approach that it is not necessary, or desirable, to push people out of the insurance they have as a result of the ACA. If Congress, working with the Trump administration, establishes a new system of insurance coverage, it can make the switch from old to new effective on a prospective basis. Over time, there would be a natural transition from the ACA to the replacement plan. A transition of this kind would mean allowing all persons who are now enrolled in an insurance plan offered on the exchanges to continue to be eligible for those plans, with premium subsidies provided under the rules of the ACA.
“It would also mean allowing all those who became eligible for Medicaid because of the expansion of the program in the ACA to stay enrolled in the program, even if a replacement plan eventually lowers the income eligibility levels for prospective Medicaid applicants. Allowing people to keep what they have today on an indefinite basis will help stabilize the marketplace and allow for an orderly, rather than a chaotic, transition.”
That seems straight forward enough. But what about, say, the 27-year-old who comes off his parents’ plan in 2017? Do we pull the rug out from under him? Well, include him then, too. What about someone who starts working full time, increasing her income beyond the Medicaid cutoff? We should want her to keep working, so let’s give her the benefit of the subsidized exchanges also, right? Then there is the person who loses his job and falls into the income level covered by Medicaid. We don’t want him to be deprived of Medicaid coverage when others who happened to lose their job in 2015 (and got the benefit of expanded Medicaid coverage) gets theirs, do we? That would be perversely unfair.
You see where we are heading. Yeah, we kinda fudged in suggesting grandfathering was a stand-alone option. In fact it only illustrates the obvious: Until the GOP can pass something that garners bipartisan support and solves the Obamacare problems it has identified, it should do nothing. That’s the ultimate “grandfathering” — leave the system in place. That is the only real solution politically or policywise that doesn’t create a raft of victims. The sooner the GOP figures this out, the better.