Republicans have been talking about repealing and replacing Obamacare since its passage in 2009 — an action that would have devastating consequences across Central Appalachia. With November’s election resulting in Republican control of both houses of Congress and the White House, soon there will be nothing to stop them.
Except for one inconvenient fact: All these years later, Republicans still have no clue what they want to replace Obamacare with.
This became exceedingly clear listening to U.S. Sen. Shelley Moore Capito, R-W.Va., on West Virginia Public Broadcasting’s The Front Porch podcast. She was unequivocal about what was going to happen: “Obamacare is going to be repealed. That’s a slam dunk.”
At the same time, she acknowledged that 175,000 West Virginians now depend on Obamacare for coverage through the law’s Medicaid expansion. She claimed concern for them, and said that’s why the repeal would include a two- to three-year transition to “try to build the best system that can continue coverage for those” — while acknowledging that the details of that replacement are sketchy at best.
“So it’s not fully formed, and that’s where the trepidation comes in.” She imagined a response from a concerned constituent: “ ‘Well, that sounds great, Shelley, You’re going to take it down but you’re not going to tell us exactly what you’re going to replace it with.’ And I can’t tell you right now what that will be.”
Capito can’t even come close. The only specifics she really mentioned were block grants and giving states more control over their Medicaid program — but block grants offer little more than a method to cut resources for states and give them the illusion of control.
Capito also claimed the replacement would leave in place many popular Obamacare provisions, including keeping the provision allowing children to stay on their parents’ policies until age 26 and continuing the ban on denying coverage to those with pre-existing conditions.
But it is impossible to just keep the parts of Obamacare that everyone likes while tossing unpopular provisions like the individual mandate, and she knows it. With a ban on denying coverage for pre-existing conditions but no mandate, there’s nothing to prevent healthy people from putting off getting coverage until they need it.
“It’s going to be a replacement vehicle that’s going to better for everybody,” Capito promised.
That’s an easy promise to make, but an utterly impossible one to keep. And that’s why Capito — and most other Republicans — aren’t even trying to explain how they’ll maintain coverage while repealing the law that made coverage possible.
The Affordable Care Act consists of three interlocking and interdependent ideas: Insurance coverage should be available to anyone regardless of pre-existing conditions; currently healthy people cannot simply decide to put off getting coverage until they need it; and subsidies are necessary to ensure that everyone can afford insurance.
The popular parts of the law that Capito wants to keep (the ban excluding coverage for pre-existing conditions) simply won’t work without the unpopular portions (the individual mandate). In fact, the main problems currently experienced by the ACA marketplaces can be traced to the weakness of the individual mandate and the small size of the penalty on those who ignore it.
Though congressional Republicans have had nearly eight years to come up with a system to replace Obamacare, they’ve got nothing. There is no reason to believe they will have anything after a two- to three-year “transition” period. (Hint: You can’t call it a transition period if you don’t know what you’re transitioning to.)
And it isn’t just Obamacare that’s in trouble. With unified Republican control of the federal government, Medicare, Medicaid and Social Security are all in grave peril, too. Speaker of the House Paul Ryan has been itching for years to phase out Medicare and privatize Social Security, and now he has the votes to do it and an incoming president willing to sign such legislation — despite his campaign promises to the contrary.
In places like Appalachia with aging, lower-income populations, the changes congressional Republicans are considering to America’s health care safety nets will be absolutely devastating. Hundreds of thousands of people will lose health care coverage. It will take all our voices lifted high and shouting hard to try to stop this oncoming disaster.
Radmacher is former editorial page editor of The Charleston Gazette and The Roanoke Times. This Land is a weekly column produced by Appalachian Mountain Advocates.