Today’s the three year anniversary of the final House vote on Obamacare. It is one ugly toddler, and its first steps are turning out to be disastrous. But is it here to stay?
From the beginning, there were three ways to replace Obama’s signature domestic policy achievement. The first and best option was that you could replace it by winning an election – and it would have to be a definitive win, not just the White House but the Senate, too. Republicans utterly failed to do this. Second, you could count on the Supreme Court to gut its central support mechanism, the individual mandate. Thanks to John Roberts, this also failed, but not utterly, since the surprise 7-2 decision allowed states the freedom to block the Medicaid expansion, a massive entitlement increase which made up the bulk of the coverage increase under the program. But after both of these failures, the general chorus in the media is that the right has to give up on repealing Obamacare altogether – that it should accept it and work to implement it. See the recent complaints from Nita Lowey and others about the lack of funding for implementation, who will certainly cite this as the reason for a clumsy launch of the online systems this fall.
They seem to have forgotten about the third path: the right can replace Obamacare if it fails. And thus far, it gives every indication of failing. It has contributed to growing premium costs. Its budget impacts have been revised only in a negative direction (indeed, the only positives have been from fewer states implementing the Medicaid expansion). It has already been stripped of one mathematically and actuarially unsound entitlement. Most Republican governors have no interest in helping implement a program they believe to be ill-thought from its inception, and even Democrats don’t want their fingerprints at the state level on exchanges and Medicaid expansions their systems can’t handle.