Whither Obamacare: Will It Go Away Even Without the Republicans?

With Republicans controlling both houses of Congress and Donald Trump winning in November, those who dislike Obamacare wanted it repealed – now.  Doing so, however, is taking longer than some people would like because Republicans in Congress don’t agree on what should replace it.  Still, it has only been a month and a half since President Trump took office, so I’m not sure people should be panicking yet.  After all, look how long it took President Obama and the Democrats to get Obamacare passed and implemented (assuming it is fully implemented even now).

One of the interesting things about the debate over Obamacare is that approval ratings for the ACA seem to have increased in the last few months.  As the title of a post by David Post at “The Volokh Conspiracy” says: “You don’t miss your water till the well runs dry” (following, I assume, on a song by William Bell).  This may be because Obamacare is now being compared against other plans, or at least features of other possible plans, as opposed to being looked at by itself.  Also, there is a lot of talk about how people who have insurance under Obamacare might lose it under one or more of the Republican plans. 

Which raises the point of this post:  Even if people are starting to like Obamacare and want to keep it, it’s unclear whether they are going to be able to.  But that’s not because of anything the Republicans are going to do.  It’s because it is unclear how long the Obamacare marketplaces are going to last, regardless of what the Republicans do. 

The number of insurance companies willing to sell policies on the Obamacare exchanges is going down.  The number of counties with only one company selling policies increased in 2017, and more companies have announced they are going to pull out of the exchanges next year.  (Also, here.)  This will likely result in higher prices and fewer choices.  The higher prices (i.e., higher premiums and higher deductibles) will cause more people to stop buying policies.¹  Also, there may be places without any companies selling policies on the exchanges.²  In other words, people are going to lose their health care coverage.

And this isn’t going to the result of anything the Republicans do.  It’s going to be because the Democrats and President Obama never got Obamacare to work right in the first place.  The Obama administration had six years to figure out how to make the health care exchanges work.  They failed.  Some will claim that since the Republicans are in charge, it’s their job to fix them. No, it’s not.  The Democrats passed the ACA by themselves in 2009/10.  The Obama administration made all kinds of changes to Obamacare once they tried to implement it.  If it still doesn’t work, it’s because the Obama administration and the Democrats couldn’t figure it out.

Which also means, in comparing the number of people covered by Obamacare with the number of people covered by whatever health care plan(s) the Republicans come up with, the proper comparison is not between the Republican plan and the number of people Obamacare covers today.³  Rather, the proper comparison is between the number of people the Republican plan covers and the number of people Obamacare will cover three or four years from now, with premiums (and deductibles) continuing to go up and companies continuing to abandon the market.  On that basis, some of the Republican proposals may not look so bad.
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¹ Because they can’t afford them – or, perhaps more accurately, because they don’t want to spend that much money on health care insurance.
² If it doesn’t happen next year, if the current trends continue, it will happen soon.
³ Or, even more so, the number of people Obamacare would have covered if it had actually worked like its supporters said it was going to work.