President Trump and Republican lawmakers have never been able to explain how they would improve on the Affordable Care Act, which they’ve promised to quickly repeal and replace with something better. Now, it’s increasingly evident that they have no workable plan and might never come up with one.
Congress blew past a self-imposed Jan. 27 deadline to introduce legislation to end the health law. Mr. Trump told Fox News in an interview that ran Sunday that a replacement for the health law might not be ready until next year. Meanwhile, Republican senators like Lamar Alexander and Orrin Hatch have started talking about “repairing” the A.C.A., or Obamacare, rather than removing it root-and-branch. And while House Speaker Paul Ryan still insists that Congress will repeal and replace it this year, his wishful statements are clearly meant in large measure just to placate the burn-it-all-down wing of his caucus.
After campaigning for years against the health care law, Republicans seem to be realizing that it will be incredibly difficult to deliver on Mr. Trump’s promise of providing a program that is better, cheaper and covers more people.
The law has extended health insurance to more than 22 million Americans. Plenty of them are calling lawmakers, showing up at town halls and marching in the streets demanding that Obamacare be preserved. Public support for it has never been higher, according to an NBC News/Wall Street Journal poll. Another poll, by the Pew Research Center, found that 60 percent of Americans say the government should make sure that everybody has health coverage.
None of the Republican plans would accomplish anything close to what the A.C.A. has achieved. A bill introduced by Representative Tom Price, Mr. Trump’s pick to run the Department of Health and Human Services, would greatly reduce the federal subsidies that help people buy health insurance. It would also eliminate the expansion of Medicaid, the health program for the poor, disabled and elderly, that has covered more than 11 million new people. Mr. Price and other Republicans also want to turn Medicaid into block grants to states, which would result in governors and legislatures cutting benefits and covering fewer people. And House Republicans have proposed privatizing Medicare by giving beneficiaries vouchers to buy private insurance.
Given the political predicament, some Republicans are now trying to constrict the program without repealing it. The Trump administration, for instance, is reportedly considering allowing insurers to charge older people who buy insurance on the federal health care exchanges premiums that are 3.49 times as much as they charge younger people, up from three times as much currently.
Another approach is to chip away one provision at a time. Congress could, for example, eliminate mental health care or contraceptive coverage, which is required of health plans under the current law. The Trump administration already tried to sabotage the law by pulling about $5 million in ads in the last few days of open enrollment at the end of January. Analysts say that decision helped drive down the number of people who bought policies on HealthCare.gov this year, compared with 2016.
If Republicans are at all concerned about the public interest and their own political futures, they ought to pull back from the chaos they have sown.