The Lessons of Obamacare

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On January 6, President Barack Obama sat down with us for one of his final interviewsbefore leaving the White House. The subject was the Affordable Care Act — the legislation that has come to carry his name and define his legacy.

It was strange circumstances Obama found himself in. He was leaving office an unusually popular president, with approval numbers nearing 60 percent. But his most important domestic achievement was imperiled. Republicans had spent years slamming Obamacare for high premiums, high deductibles, high copays, and daunting complexity. Donald Trump had won the White House in part by promising to repeal the ACA and replace it with “something terrific.” Both houses of Congress would be controlled by Republicans who appeared set to carry out his plan.

But over the course of the next 70 minutes, it became clear that Obama didn’t think they would get the job done. If he sounded unexpectedly confident, it’s because he believed the wicked problems of health reform — problems that bedeviled him and his administration for eight years — would turn on the GOP with equal force.

“Now is the time when Republicans have to go ahead and show their cards,” he said. “If in fact they have a program that would genuinely work better, and they want to call it whatever they want — they can call it Trumpcare or McConnellcare or Ryancare — if it actually works, I will be the first one to say, ‘Great; you should have told me that in 2009. I asked.’”

Two months later, the release of House Republicans’ replacement plan — the American Health Care Act — has made Obama look prescient. The bill quickly placed Republicans under siege from both the left, which has found more to like in Obamacare as its survival has become threatened, and the right, which attacked the replacement as unrealistic and ill-considered, and, most damning of all, as “Obamacare 2.0.”

The biggest problem Republicans face, though, isn’t from activists in either party. It’s from the tens of millions of Americans who now depend on Obamacare, and their friends, families, co-workers, and neighbors. They have been promised a replacement that costs less and covers more, and the GOP’s plan does neither.

According to the Congressional Budget Office, the AHCA would throw 24 million people off health insurance over the next 10 years and leave the remnant in plans with higher deductibles, higher copays, and less coverage. The law would let insurers charge older Americans 500 percent more than younger Americans, and the sparer subsidies wouldn’t adjust to the local cost of insurance coverage, and thus would be insufficient in many areas. This is not the “something terrific” Trump promised, nor the kind of health care that polling shows Americans want.

We are reporters who have covered health care, and the legislative ideas that became the Affordable Care Act, since before Obama’s election. In the course of that reporting, including recent conversations with Obama and dozens of elected officials and staffers responsible for the Affordable Care Act’s design, passage, and implementation, we have unearthed several lessons from the law, which current and future health reformers should heed.

At the moment, Republicans are ignoring most of them.


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