What will happen to Obamacare?

by Gerard J. Gianoli, MD •

That said, politics is a blood sport, so Republicans shouldn’t expect much support from the other side of the aisle. With the Democrats ready to lay any untoward effects of repealing Obamacare at the feet of the GOP, many in the Republican camp are talking about “fixing” Obamacare rather than voting for an outright repeal.

Gerard J. Gianoli, MDRepublicans are sorely mistaken if they try to patch up Obamacare rather than repeal it. You don’t pour money into propping up a condemned, collapsing house just because you like the large flat-screen TV. Similarly, you don’t keep the sprawling 1,000+ pages of the ACA, with all of its spin-off regulations, just because you like the ability to keep your kids on your health insurance until they’re 26.

The Case against Repealing Obamacare

Recognizing that the ACA is not viable in its current iteration, some—mostly on the left—have advocated “fixing” Obamacare. This group cites the problems that would come with a repeal of Obamacare.

First and foremost are the 20 million Americans “newly insured” due to Obamacare. Critics of a repeal argue that these 20 million Americans would be without healthcare. They also point to the most popular aspects of Obamacare:

  1. The guarantee provision, which prevents insurance from denying coverage for preexisting illness, and;
  2. The ability to maintain children on their parents’ insurance until they are 26 years old.

These provisions are almost as popular with Republicans as they are with Democrats.

Along with these concerns comes the recognition that any law in place for six years will have adjusted many facets of society, and the outright repeal of such a law will have far-reaching implications. What about the billions of dollars the healthcare industry has spent adjusting to Obamacare? How many doctors have sold their practices to become employees, at least in part in response to the effects of Obamacare? (Answer: roughly 200,000, or nearly 25% of physicians [“The Physician’s Association 2014 Survey of Physicians.” Published September 2014. Available at physiciansfoundation.org]).

So, just when all of these societal elements are becoming adjusted to Obamacare, the incoming administration wants to change the rules. You can expect many powerful lobbying groups to push for fixing rather than repealing the ACA.

The Case for Repealing Obamacare

Of those 20 million newly insured, 16 million receive Medicaid and would continue on Medicaid even with an outright repeal of Obamacare. The only concern is the nearly five million who have subsidized private insurance through the exchanges. But, given the fact that those five million newly insured have $6,000 deductibles with the typical Bronze plan, an insurmountable hurdle for most, they are—for all practical purposes—uninsured.