I’ve spent much of my young writerly career railing against the policy debacle that is Obamacare, first at the American Spectator and then here at Rare. I argued that the law would prove far more costly than was initially estimated and that it would unleash a death spiral inside the exchanges — fears that have proven valid. I rolled my eyes at conservatives who made common cause with Obamacare, who said Republicans should learn to live with it and called the right’s opposition to it “Waterloo.”
Yet now that repeal is almost here, I find myself nervous.
That isn’t because I’ve wilted at all in my contempt for Obamacare, whose primary achievement has been to spend an exorbitant amount of money insuring relatively few people off of a narrower and more costly menu of insurance plans. It’s because opposition is always easier than policymaking, which is what Republicans must now do — no more one-page repeal bills, no more vapid speeches. It’s an enormously difficult task and it may yet prove to be a Sisyphean one.
The GOP is presently in a pickle. It’s won literally thousands of seats in state legislatures, governor’s mansions, the House, and the Senate by vehemently resisting Obamacare at every turn, and rightly so: the cavalier and complacent declaration by liberals that the public would fall in love with the law once it began to take effect has proven wrong. Instead, Democrats found themselves trapped in a deadly dynamic where they were blamed for every burp in the health care market. All those premium increases, losses of coverage, skyrocketing deductibles, collapsing online exchanges, all were pinned on Democrats and adversely affected their political fortunes.
Now it’s Republicans who are about to catch this hot potato. Once they start overhauling the health care market, they’ll own it just as the Democrats did, and will suffer accordingly every time something goes wrong. And, as with all government engineering and de-engineering projects, things will go wrong. Obamacare isn’t a leech on the health sector that can be neatly extracted; it is the health sector, having drastically reshaped its contours. A cursory search of the Federal Register finds 258 packages of rules pertaining to the Affordable Care Act, with the first of them containing 104 pages of regulations. My friend Penny Starr calculated all the way back in 2013 that the stack of Obamacare regs was already 30 times longer than the (monstrous) law itself. Striking all of these in one blow will have consequences that Republicans can’t begin to fathom.
Repealing Obamacare will be like a mini-Brexit. Just as Britain’s disentangling itself from the European Union is a vastly complex process that will take years, so too will striking the Affordable Care Act be a laborious unraveling.
There’s also the problem of how much to repeal. If Republicans assent to Trump and leave in place provisions that outlaw discrimination against those with preexisting conditions and allow “25-year-old children” (the left’s most mad coinage yet) to remain on their parents’ insurance, they’ll find that costs remain stubbornly high. And if they strike the individual mandate without repealing the pre-existing conditions measure, the death spiral will only worsen, as young people abstain and the sick stay in. Beyond that, remember too that Republicans can’t do much of this anyway, since their filibuster-vulnerable majority will force them to cram everything through the reconciliation process.
In other words, none of this is going to be easy. Perhaps Republicans would be wiser to table the Obamacare repeal and take a year to assemble a real, comprehensive, ready-for-primetime replacement, one that unlatches the federal government from the health sector and creates a genuine insurance marketplace. In the meantime, they could pick lower-hanging fruit: President Obama’s eleventh-hour regulations blitzkrieg, the temporarily halted overtime rule, the corporate tax, the REINS Act. Just make sure that Donald Trump isn’t the second president that Obamacare sinks.