How Republicans Can Escape Their Health Care Dilemma, Part 1: Universal Catastrophic Coverage

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The demise of the American Health Care Act (AHCA) on March 24 was a humiliating defeat for both President Trump and Speaker Paul Ryan, both of whom had pledged the repeal and replacement of Obamacare would be the first order of business under a Trump administration. Now they both plan to move on to tax reform and it remains to be seen when or how a repeal and replacement effort will be resurrected.

I sit in an ivory tower, so perhaps my views will be dismissed as hopelessly unrealistic. But having studied health reform for more than four decades, the prospects for success are not as dim as most might think. This three part series by no means exhausts the possibilities, but should give readers a rough sense of three possible paths out of this mess. These include:

  • Universal catastrophic coverage (Part 1)
  • Universal safety net (Part 2)
  • Responsible federalism (Part 3)

President Trump has argued repeatedly for “coverage for all.”  The CBO score showing that the AHCA would result in a loss of coverage for 24 million Americans was devastating for its political prospects [1]. Yet Obamacare, despite leaving tens of millions of Americans uninsured, is universally viewed by Republicans as fiscally unsustainable over the long term. Therein lies the Republican’s political dilemma.


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