President-elect Trump hasn’t even been sworn in yet, but congressional Democrats have already initiated an offensive to pre-empt his campaign promise to repeal and replace Obamacare. Late Monday, Senate Democrats took to the floor, Twitter, and Snapchat to hold a talk-a-thon in protest of these upcoming efforts.
Things got off to a rocky start, however, when Senate Minority Leader Charles Schumer tweeted the wrong battle cry:
He later deleted the tweet, dispatching instead the proper snark: Republicans want to “Make America Sick Again.” Of course, after losing the sure-bet presidency, what the Democrats really want is to “Make America Pick Again.” But since that won’t happen for another four years, they hope to set the governing tone instead.
Beyond their slick slogan, Democrats seek to frame the debate by pushing the narrative that Republicans want to repeal Obamacare and deprive 20 million people of health insurance without a replacement plan. To succeed in their attempts to repeal and replace Obamacare—and avoid a midterm drubbing—Republicans must correct the terms of the debate. They also have to do it soon and without any wonkiness. Here’s a four-step template.
Step 1: Stress There Are Winners and Losers
Yes, Obamacare is horrible. Yes, it increased health-care costs for many people. No, you cannot keep your doctor or your plan. These points must all be made. But the repeal and replace crowd cannot focus solely on those realities for two reasons. First, Obamacare proponents can easily point to individuals who benefit from the provisions of the Affordable Care Act. Second, these points do not counter the now-growing narrative that 20 million Americans will lose their insurance if Congress repeals Obamacare.
Instead, opponents of Obamacare must return to first things: acknowledge, frankly and sincerely, that the Affordable Care Act has helped some Americans (and assure them that the replacement plan will also protect the sick and vulnerable). Then stress that while the law created some winners, it also created many more losers, and that Obamacare supporters are blindly ignoring this reality.
Step 2: Dispel the ‘20 Million Winners’ Illusion
Next, the repeal and replace faction must counter the false impression that the Affordable Care Act created 20 million winners.
Here, proponents of repeal and replace should first remind Americans that the 20 million figure is merely an estimate from the Obama administration. As the Daily Signal highlighted last month, that government figure comes from survey data—not actual enrollment data. Actual enrollment data, compiled by the Heritage Foundation, tells a different story. “The researchers found that just over 14 million people gained coverage from the end of 2013 to the end of 2015. Of those 14 million, 11.8 million gained their insurance through Medicaid [i.e. welfare] and 2.2 million through private coverage,” the Daily Signal reports.
There are many other problems with the 20 million figure, which Dr. Scott Gottlieb, a former Food and Drug Administration deputy commissioner and fellow at the Heritage Foundation, laid out at length for Forbes. These too should be highlighted.
But adjusting the 20 million figure downward to reflect a more accurate count will still result in a fairly large number of Americans obtaining insurance under the Affordable Care Act. The repeal and replace crowd must respond forcefully with one simple but important truth: Health insurance does not equal health care.
Step 3: Highlight the Incalculable Number of Losers
Next, those pushing repeal and replace must remind the public that while Obamacare helps some individuals, it harms many more. Obamacare boosters seem incapable of acknowledging this truth. They portray the Affordable Care Act as merely having some minor glitches which, if Republicans only helped, could be addressed.
Nonsense. It isn’t a glitch that the Affordable Care Act created losers, it was the law’s intent. Obamacare sought to cover older and sicker Americans by providing them government subsidies (making the taxpayers the losers) and ripping off younger and healthier Americans. Because young and healthy Americans stayed away from the exchanges, to remain fiscally stable, insurance companies were forced to increase deductibles and co-pays and limit doctor and hospital networks, making the healthy individuals who did buy insurance even bigger losers.
The more indirect losers—such as workers unable (or unwilling) to find full-time employment because of the Obamacare mandates, as well as doctors in private practice forced to sell out to hospitals—are more difficult to quantify, but they are just as real.
Step 4: Replace Obamacare With a Better Law
Finally, after correcting the misleading 20 million figure and stressing that the supposed benefits from Obamacare come at a huge cost, repeal and replace congressmen should focus their efforts on a replacement plan that addresses the biggest concerns for the public: pre-existing conditions, insurance caps, and coverage for adult children.
While these efforts will be the final step, Republicans need to start broadcasting their plans now, before Schumer’s “chaos” catch-phrase takes hold. Here are some simple points the repeal and replace crowd can make.
The Left hammers the need to protect those with preexisting conditions, but then acts as if Obamacare is the only way to do this. The public needs educating, first on the reality: individuals with preexisting conditions who were unable to obtain insurance before Obamacare were only about 14 percent of the population. Second, proponents must stress that Obamacare did not adequately address the issue. It neither insures all those with preexisting conditions (about 10 percent of individuals with pre-existing conditions are still uninsured), nor does it assure health care for the seriously or chronically ill.
While those with uninsurable preexisting conditions represent just a small portion of our society, a replacement plan must address their needs, both for moral and pragmatic reasons. But what many do not know is that the Health Insurance Portability and Accountability Act of 1996 already provides some protection for those with pre-existing conditions who lose their insurance.
While the public thinks of HIPAA as a law protecting the confidentiality of medical records, prior to Obamacare, HIPAA prohibited both group insurance plans and plans obtained in the individual market from excluding coverage of pre-existing conditions, under specific circumstances.
HIPAA’s protections were not without gaps. But an Obamacare replacement plan can address those limitations separately, and without upending the entire insurance market, such as by providing grants to states to fund high-risk pools. That’s something a majority of states offered prior to Obamacare, but then discontinued, in whole or in part, as a result of Obamacare. The concern over insurance policy caps should be treated similarly.
The final “winner” to address: adult children. Other than adult children with chronic health conditions, the real beneficiaries of Obamacare’s 26-year-old coverage mandate are the parents. This mandate gives them peace of mind that if something happens to their children, they will have coverage. But that benefit comes at the cost of higher premiums for families with children. The easy solution: Require insurance companies to provide two quotes: one covering children up to 26 and one that doesn’t. The true cost will no longer be masked, and parents can decide then if the cost is worth it.
Finally, Congress should add provisions for tax-free contributions to health savings accounts for the payment of medical expenses and for the purchases of health insurance (both in the individual market and under COBRA), and consider, in the short term, grandfathering states that have already expanded Medicaid.
Then stop. Americans don’t want another comprehensive health care overhaul. We’re exhausted hearing about it, learning about it, and trying to navigate through the changes. Businesses and insurance companies also need stability. Let everyone have a hiatus from the health-care debate—at least until 2018’s midterm elections.