Republicans Start to Get Real on Health Care

Which tool?

Photographer: Christopher Furlong/Getty Images

Now that Republicans control both the executive and legislative branches, their plans to replace Obamacare -- yes, they exist -- will amount to more than just hot air. One new proposal shows they’re beginning to take their newfound responsibility seriously.

The bill, introduced by Senator Bill Cassidy of Louisiana with three Republican cosponsors, would keep the taxes and fees that fund the Affordable Care Act, and allow states to keep the basics of the law, including Medicaid funding, if they choose. States that opt out would receive funding to automatically enroll all uninsured residents into a plan covering catastrophic care. The individual mandate and other requirements would be history. “If we address that, we’ve repealed Obamacare,” Cassidy told Bloomberg News.

Catastrophic care plans would be a bare-bones replacement for coverage available under the current law. And they’re a long way from President Donald Trump’s pledge to replace Obamacare with something better, cheaper and more extensive. But that vow was always a fantasy.

Last week, the Congressional Budget Office released its analysis of Representative Tom Price’s 2015 Obamacare repeal bill, which provides no replacement. Price is Trump’s nominee for secretary of Health and Human Services. The repeal plan would separate 18 million patients from their insurance after only one year, and cause premiums to soar. Over a decade, millions more would lose coverage.

Even if the CBO analysis overstates the damage of Price’s bill, the consequences would be dire -- and utterly predictable. It’s not possible to gut funding for health-care insurance, as Price’s plan would do, and expect that millions won’t lose their coverage.  

Cassidy’s bill implicitly acknowledges that. In a polarized Senate, the bill is unlikely to advance far. Many Democrats will find it too skimpy; many Republicans, too generous. Both sides are unduly focused on destroying or defending Obamacare at all costs, instead of figuring out how to correct its deficiencies and build on its achievements.

Trump, meanwhile, appears to have embarked on a course to undermine the current law while having no replacement. The White House is playing a dangerous game. But the emergence of congressional Republicans willing to grapple with reality is an encouraging sign.

Correction, Jan. 26: Changes fourth paragraph to reflect that CBO analysis was of a bill to repeal the Affordable Care Act, not replace it.

(Corrects characterization of 2015 Price bill in 4th paragraph.)

To contact the senior editor responsible for Bloomberg View’s editorials: David Shipley at davidshipley@bloomberg.net.