Repeal Obamacare? GOP Should Be Careful What They Wish For

For years, Republicans have been condemning Obamacare and vowing to repeal and replace it. Now that they'll soon be able to do that, they're like the dog that caught the car: Now what?

I'd be willing to bet a month's worth of premiums that this is what's happening right now: The best PR pros money can buy are quietly developing strategies to help Republicans deal with two different scenarios, neither of which many of them gave a second's thought to before the election, and both potentially catastrophic for the Republican brand. To say nothing of the health and well-being of a whole lot of people.

Under the first scenario, the US health care system is imploding. Which is exactly what will happen if Republicans repeal the law and either delay replacing it until after the next election, as some lawmakers seem to favor, or replace it sooner rather than later if the replacement is based on ideology-driven ideas that even some conservative health policy experts know could do more harm than good.

That's the worst-case scenario. The plan being developed by the PR pros is all about how to shift blame away from Republicans when they unwittingly set off health care Armageddon.

The other, more likely, scenario: The PR shops will help Republicans convince the public they've repealed and replaced the law when all they will have done is tweak it to the satisfaction of a few lobbyists -- in particular, lobbyists for the health-insurance industry. So much for draining the swamp.

The challenge for House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell will be convincing the rank and file (and, for that matter, President-elect Trump and his transition team) that repealing and replacing the law as they promised on the campaign trail would be political suicide. That might not be easy. What I learned when I testified before Congress during the health care reform debate seven years ago was that lawmakers' understanding of how health insurance works in this country is not based so much on reality as it is on what they've been told by the corporate lobbyist or partisan think tank "fellow" they hold in highest esteem.

I also learned that more than a few conservative members of Congress place a greater priority on reducing government spending than on expanding coverage. To them, the term "health care is a human right" is just a big-government-loving lefty slogan. Their preferred term is "individual responsibility."

Take Senate Finance Committee chair Orrin Hatch, for example. As Kaiser Family Foundation CEO Drew Altman noted in a recent Wall Street Journal column, Hatch is on record as saying that "conservatives cannot allow themselves to be browbeaten for failing to provide the same coverage numbers as Obamacare...We cannot succumb to the pressure to argue on the left's terms."

The problem for Hatch and other like-minded Republicans is that the Obamacare replacement ideas they keep proposing would lead to such a destabilized health insurance marketplace that tens of millions of people, including millions who voted for Republican candidates last month, would no longer have access to decent and affordable coverage. That would not be good for the Republican brand. Individual responsibility only gets you so far.

The replacement ideas most often put forth -- "allowing" insurers to sell coverage across state lines, establishing high-risk pools for people with pre-existing conditions and encouraging more people to enroll in health savings accounts -- make for good sound bites, but they simply won't keep most of the 22 million Americans who've gained coverage under Obamacare from being forced back into the ranks of the uninsured. What's more, those ideas not only are not new, they've been proven to be of little benefit to anyone except the healthiest and wealthiest among us, as Sabrina Corlette, who heads Georgetown University's Center on Health Insurance Reforms, pointed out in a recent commentary.

The reason Republican leaders have called in the PR pros is because of what they undoubtedly have been hearing from my former colleagues in the health insurance business: If they rush to repeal Obamacare and think they can replace it with a plan based on those ideas, they'll have a PR nightmare on their hands in no time flat. And it won't help to postpone the replacement for a couple of years. The uncertainty created would lead insurers to abandon the Obamacare exchanges well before two years had passed.

As that reality sinks in, party leaders will draft legislation that will be based on the insurance industry's wish list and try to sell it as making good on their repeal-and-replace campaign promise. Among the items on that wish list: allowing insurers to once again charge people in their 40s, 50s and 60s far more than younger people for the exact same coverage, letting them once again take the status of an applicant's health into consideration when pricing their policies and making it legal again for them to sell inadequate or even worthless coverage to gullible Americans.

You might recall that Trump and other Republicans have said that they absolutely will get rid of the Obamacare provision that makes it illegal to remain uninsured -- which most people don't like -- but that they absolutely will keep the Obamacare provision that makes it illegal for insurers to refuse to sell coverage to people with pre-existing conditions -- which most people love. You can be certain that more than a few of my former colleagues are explaining why that won't work, just as they explained it to Obama and congressional Democrats back in 2009. Obama had campaigned against the individual mandate but agreed to it after insurers told him what had happened a few years earlier in Kentucky and Washington state. Lawmakers in both states passed laws requiring insurance companies to accept all applicants regardless of their health, but didn't pass an individual mandate. They quickly reversed course, however, when the number of older and sicker applicants far outnumbered the younger and healthier ones. That's what creates the dreaded "death spiral" that sends health insurers running for the exits.

All this is to say that repealing and replacing Obamacare (which Republicans are loath to admit was modeled after a plan developed years ago by fellows at the conservative Heritage Foundation) is much easier promised than accomplished. And it's why the busiest people in Washington these days are the spin doctors.