President Trump and congressional Republicans are riding high into the New Year with a legislative victory under their belt: tax reform. The passage of this tax package was both necessary and possible only because the GOP failed at health reform first.
The package did include a body blow to the Affordable Care Act: It eliminated the tax penalty associated with the law’s individual mandate, gutting the requirement to buy government-approved health insurance. This is an important move: It effectively ends an unpopular penalty that disproportionately burdened low-income Americans.
But Republicans, and Americans of all stripes, should not accept this elimination of the mandate penalty as a “repeal of Obamacare” or anything close to it. In fact, this latest move should be a starting point, not an ending point, for the next legislative reforms addressing healthcare.
Eliminating the individual mandate will not solve the core problems that most people care about under Obamacare (high costs, limited choice, restrictive networks), but it will make it easier for Congress to address these core issues.
Democrats constantly touted one major talking point against the repeal and replace bills advanced this summer: that 22 million Americans would “lose coverage” without Obamacare as is. They were occasionally joined by an off-message President Trump who tweeted that the repeal and replace effort was “mean,” and Sen. Susan Collins, R-Maine, who used the coverage numbers as justification for her “no” vote.
Despite the fact the Republican bills were far from a true, full repeal (they did not repeal the law’s insurance regulations) and they all included some modified form of the Obamacare subsidies for private insurance, the Congressional Budget Office rated them poorly on the number of insured individuals due mostly to their lack of an individual mandate. CBO projections, fair or not, weigh heavily on policy debates.
A close look at the CBO’s analysis showed that, at the time, their model attributed 73 percent of the projected difference in coverage between current law and the GOP plans to the individual mandate. This significantly changes the meaning of the numbers: 16 million of 22 million are in the “choose” category, not “lose.”
This is the side of the story that Democrats don’t want Americans to hear: What does it say about the ACA that millions of people, even people eligible for subsidies, would rather go uninsured than buy an Obamacare plan? The value is so low, and the cost so great, they have to be forced to buy it.
But removing the element of force doesn’t solve the whole problem. Americans still can’t find the insurance they want or need at a price they can afford. That’s the problem the GOP should focus on solving now. And they should feel more free to do so, now that one of the Democrats’ most misleading and damaging talking points is muted.
The failed GOP foray into health reform was hard to watch in 2017. In Republicans’ defense, they were working with very small margins, using a process that limited the scope of what was possible. But now that tax reform has passed, congressional Republicans and Trump have proven they can work together in good faith, compromise, and pass good legislation, even if it’s not perfect.
Health reform won’t be any easier the second time around: in fact, in some ways it will be harder. The margin has only gotten smaller due to the loss of a Senate seat. But in other ways, the Republicans will benefit from lessons learned through both the experience of failure, and more recently, success. They have the momentum to build upon now, and voters are counting on them to get healthcare right.