David M Rothschild on Posted on

On March 23, 2010 President Barack Obama signed the Patient Protection and Affordable Care Act into law. The law was mostly enacted by 2013; from 2013 to 2017 the rate of uninsured Americans fell from about 17 percent to 10 percent. The law also mandated a reasonably high level of coverage for any insurance plan. There were many problems with the new healthcare bill, popularly known as ObamaCare; premiums (what you pay yearly to have insurance) and deductibles (what you pay each time you go to the doctor) could be higher than many desired and many still do not have a healthcare insurance. And, one aspect of the law is particularly unpopular; it requires people to buy health insurance or face a penalty. But, overall, it was a dramatic improvement in coverage.

Coverage1

The Republican opposition voted to repeal ObamaCare more than 50 times before taking power in 2017. They built their case to America, while capturing Congress, on the basis of repealing ObamaCare. The problem is that they hate ObamaCare because it includes a tax on high income. But, they built their case on lowering premiums and deductibles, and getting more people covered. So, it was a bit awkward when they took power and had the power to actually repeal the law. They settled on a new law that would be a $1 trillion tax cut that would gut the healthcare: raising premiums and deductibles so high people will drop coverage, sending sending the uninsured rate HIGHER than before Obamacare, and gutting regulations that ensure that the health insurance that remains is useful.

Americans bought Republicans snake-oil: Republicans won power without ever defining how they would replace ObamaCare. They talked about making healthcare “better”, but actually gutted health insurance. They were never pressed to present a plan that could be evaluated. So even though this outcome was obvious to you and me, it was not to the millions of Americans who are not political junkies. And, it was not like the Democratic plan was well known. There was mass ignorance of the status quo; Americans were not supportive of Obamacare, because had no idea what was in ObamaCare.

Thus, being against GOP/TrumpCare could be a successful strategy. The bill is already historically unpopular. And, we know from experience that running on a repeal saves people from having to defend a plan. But, while there are risks, I think there is a huge upside to endorsing a bill that would federally mandate that anyone can buy-in to Medicare and/or Medicaid.

Coverage2

1) This chart would be very powerful. Imagine just showing the red and gold lines everywhere. Pushing a simple idea: Democratic plan approaches 100 percent coverage, while Republican plan will leave 50+ million uninsured. Sure,, campaigning against GOP/TrumpCare is strong, but campaigning for 0 percent uninsured is stronger juxtaposition.

2) If GOP/TrumpCare passes, ObamaCare is dead. No one on the left is going to fight for the incremental market-based solution again. Great piece by Ezra Klein.

3) Medicare buy-in is widely popular:

Figure3

4) Democrats could really use a positive policy position. Something to rally around, something to claim the mantle of concrete, positive policy.