Jim Capretta and Ramesh Ponnuru, in separate pieces, offer some gentle truth telling about Obamacare. It’s not going to implode of its own inherent economic faults anytime soon. Ponnuru: “The law will continue to be implemented, with the administration making whatever revisions it thinks necessary.”
And even if Republicans gain control of the White House and Congress, there are limitations to what a GOP president would do. For instance, maybe President Rand Paul would decide to disallow the federal health exchange from paying premium credits to 10 million Americans. As Capretta puts it, “A reversal of this kind would be politically tumultuous, to put it mildly.” Adds Ponnuru: “It seems unlikely that Congress would pass legislation to strip coverage from millions of people.”
And that’s probably even with a reasonable replacement plan all lined up. Just a few years after one massive, convulsive change, Republican are going to offer another massive, convulsive change? What’s more, while center-right policymakers are cooking up various reform plans, one ingredient needs to be in all of them: universal coverage as an explicit policy goal. As Avik Roy wrote earlier this year:
No conservative politicians oppose universal public education; instead, we champion reforms that improve the quality of public education that poor Americans receive. Ensuring that every American has access to quality health coverage is a legitimate goal of public policy, and it can be done in a way that expands freedom and reduces the burden on American taxpayers.
There is no “repeal” in the Roy plan. Broadly he would (a) deregulate the exchanges, (b) gradually raise the Medicare age, effectively funneling more people into the exchanges, and (c) put acute-care Medicaid patients into the exchanges, “while returning its long-term care and disabled populations fully back to the states, free of federal interference.” Whatever the flaws in the Roy plan, it has a big advantage in that it works off the status quo, rather than attempting to scrap the status quo. (See: path dependence.)