What are you talking about? What exactly did the Republicans do to Obamacare? Obamacare is the same today and it was a year ago when Obama was still President? What exactly has changed?
Those are fair questions, and you deserve good, honest answers. When The Court ruled that individual states could opt out of expanding medicaid it was the red state governors that acted quickly to block expansion in their respective states. They argued that their States could not afford expansion. When it was pointed out that expansion would cost the Red States nothing, they responded by noting that eventually the Federal subsidy would be reduced and that then the cost would be too high to be affordable. The Red State Governors said their states could not even afford their eventual 10% share. Then the economic studies came in and they showed that the 10% State costs would be recovered by an increase in State tax revenues coming from expansion. In other words, the net cost of expansion was estimated to continue to be zero. At this point the Red State governors had no reasonable rejoinder, and it was clear that their blocking of expansion was 100% political. It made absolutely no sense economically. They were in fact preventing access of hundreds of thousands in their States to routine medical care and at the same time committing political malpractice by causing their Federal Tax Paying Constituents to pay, via their Federal taxes, for expansion in the blue States. At this point a few Red State governors decided, belatedly and under great pressure, to stop blocking expansion. However the majority of Red State Governors continued to block expansion.
What the average person did not understand was that Obamacare was predicated on their being a
minimum income requirement to qualify for insurance premium supplements in the insurance exchanges. Those under the minimum, that were not already covered by medicaid under state rules, where intended to be picked up by medicaid expansion. But of course these people now fell through the cracks in states that blocked expansion. They had no access to routine medical care. Obama care was to have covered these people through expansion, but now their only access continued to be through extraordinarily expensive emergency room care. A problem Obamacare was intended to solve, but could not because the Red State Governors prevented it by blocking medicaid expansion. The Red State Governors had indeed succeeded in throwing a giant monkey wrench into the heart of Obamacare!
The Obama administration had negotiated with insurance carriers promising to mandate that everyone over a certain age not covered by medicaid or medicare would be mandated to purchase insurance coverage or pay a penalty. The promise of bringing millions of young healthy participants into the insurance market, but with relatively low premiums, was enough to get the insurance companies to agree to cover those with pre-existing conditions without a rate increase. Obama administration agreed to reimburse carriers for losses. The Republicans have repeatedly tried to eliminate the mandate. That would naturally throw yet another monkey wrench into the works. They have also been recalcitrant in going along with reimbursements to carriers. Now it appears that the new tax bill may include an elimination of the mandate, which will surely cause rates to go up. Keeping the carriers guessing is certainly not helping to hold rates down.
In summary, at every turn, the Republicans have done all within their power to wreck Obamacare as it was originally intended to work. Instead of working with Democrats to address the obvious flaws in Obamacare, such as attaching coverage to employment , and failing to ditch the McCarran Ferguson Act, which would greatly facilitate insurance competition and bring uniformity to coverage and rates by bringing insurance under department of commerce regulation, they are continuing to do all in their power to destroy what little improvement Obamacare originally promised to deliver. Obamacare is terrible, but if the Republicans had cooperated with the Democrats at least it would have been less terrible than what we had before. Let us not lose sight of Obamacare's origins, a plan dreamed up by a Republican think tank; a deeply flawed health care plan that served as the model for Massachsetts' O'Romneycare. Obama thought he'd get at least some support among Republicans by choosing a Republican "free market" style plan. He was wrong, but he couldn't have envisioned the fervor with which the Republicans would try to wreck the plan once adopted. There is a bright side however. Health care in the U.S. will eventually become so expensive and such a total mess that the country will be driven to single payer, which is what most other advanced countries have. Single payer is likely the only thing that can bring costs down in a market where pricing is nearly inelastic. I am confident we will try everything else first. And everything else is doomed to failure of course because everything else can only work well where there is at least a modicum of elasticity in pricing. *
____________________
The Swiss system is an interesting exception. The Swiss have a health insurance market, but it is very highly regulated. And that is something the mere thought of which is anathema to every red blooded Republican insurance executive. The Swiss system is the second most costly. The U.S. System is only 100% more costly than the Swiss with less good outcomes. Even if the U.S. was to move to single payer it would not mean the death of health insurers, just as medicare does has not eliminated the insurance market for those over 65. In fact medicare supplemental insurance is highly lucrative, as anyone who owns United Health stock can tell you.
