When Democrats passed the Affordable Care Act in 2009, conservative voters expressed vitriolic outrage. This anger only grew worse in 2010, when President Obama signed Obamacare into law while displaying his famous “We Won” smugness. Picking up on that anger, Republican lawmakers promised at the time that they would repeal the law if only given the chance.
That was then, this is now. While Republican lawmakers are hedging on repealing Obamacare, so are voters.
A new Fox poll finds that only 23 percent of voters favor doing away with Obamacare entirely. (I’ll refer to these voters as the End It, Don’t Mend It group.) That’s down from a high of 39 percent in 2013. The shift has partially gone to the 34 percent who now favor a partial repeal (a.k.a. Mend It, Don’t End It). That’s up from 22 percent in 2015. And for the first time, 28 percent, a new high, favor expanding the program, whereas 13 percent, a new low, favor leaving it as is (or the Pass It, then Expand It coalition).
These numbers don’t bode well for the repeal option. Although End It, Don’t Mend It makes for a great battle cry, it never really had a chance at winning. Not so much because voter interest for full repeal has consistently been below 40%, but rather because it’s based on free market solutions, thus violating the First and Second Laws of Political Dynamics.
The First Law states that once a government program is created, it may take different forms, but it cannot be destroyed. The Second Law states government programs may occasionally wax and wane, but eventually always increase in size. As political parties, Democrats and Republicans both adhere to these two natural laws; they just approach them from different perspectives.
As to the Pass It, then Expand It group, they would be getting their way if Hillary Clinton won on November 8. Without a doubt, a President Hillary Clinton would have expanded the program even given its disastrous beginnings, cost overruns, and broken promises.
This leaves the Mend It, Don’t End It group, which includes many Republican governors who have used Obamacare’s insurance exchanges and Medicaid expansion features to expand their respective state’s healthcare programs. If Obamacare ends, states will be left to either pick up the tab or cut programs. So, the fight really comes down to the issue, as usual, of having access to someone else’s money.
How bad will it be? The government always provides an answer in context of the First and Second Laws of Political Dynamics.
This week, the Congressional Budget Office (CBO) reported that the repeal of Obamacare would result in an increase of the uninsured by 18 million in the first year of repeal. During that time, insurance premiums will increase approximately 20 to 25 percent. Later, the uninsured would increase to 27 million, and then to 32 million in 2026, with a corresponding doubling of premium costs. The CBO has a history of bad projections, but the point is those states that have relied on federal Obamacare money will see themselves footing their own bills.
Governor Kasich of Ohio is one of the more vocal Republican proponents of Mend It, Don’t End It, and recently wrote a six-page letter to Congress requesting they save important aspects of Obamacare. But what form will a revised Obamacare program take? If Kasich had his way, the answer would be his Ohio model, which Kasich continuously hypes with great fanfare, using numbers from a recent state report.
Normal folks often make a big mistake in trying to make sense of large government programs by getting into program weeds. As they get overwhelmed with facts and figures, and not knowing whom or what to believe, they just give up and gently sink back to a life of beer, pizza, and football.
For example, to understand the status of Kasich’s Ohio model, you don’t really need to know more than that Kasich originally estimated Ohio’s Medicaid expansion would cost taxpayers approximately $4 billion between 2014 and 2016. But in reality, the program has cost taxpayers nearly $7 billion for those years, and is estimated to reach nearly $8 billion over budget by the end of 2017.
The primary reason for these costs is Kasich initially predicted 365,000 adults would sign up in the first year. But within seven months, the program had already exceeded its first-year projections with more than 650,000 added to the program. According to Kasich’s report, by May 2016, the total rose to 702,000. That type of user increase doesn’t lend itself to decreased costs when dealing with government programs, regardless of what any politician tells you.
In regards to Kasich’s rosy report for Ohio, Rea S. Hederman, executive vice president and chief operating officer for the Buckeye Institute, told PJ Media,
Most of the statistics in the survey rely on phone survey data. This is not a statistically valid technique that tells you much about the value of Medicaid to all beneficiaries. The best empirical research found that Medicaid did not improve many of physical health conditions but did provide some peace of mind to beneficiaries.
The fact remains that Ohio Medicaid expansion has experienced much larger enrollment than anyone anticipated, and these new enrollees are more expensive than was projected. As a result, the cost to state taxpayers will be higher than originally projected.
Kasich claims to be concerned with preserving only certain parts of Obamacare. However, when you decipher his speeches and writings, Kasichcare is basically Obamacare.
After all is said and done, given all this political pressure, it looks like the Republican Congress will probably follow a Mend It, Don’t End It approach with a CYA twist, also advocated by Kasich. Congress most likely will hide behind Repeal It, then Replace It, effectively allowing them to claim they kept their promise to repeal Obamacare, but at the same time not violate the First and Second Laws.
As I write this, Donald Trump is enjoying his first weekend as president. It will be interesting to see how Trump operates under the First and Second Laws; not only with Obamacare, but with other aspects of the federal bureaucracy. I wish him the best. But I’m a physicist by training, and if there is one thing I’ve learned over the years it’s that “It’s not nice to fool Mother Nature” — because Mother Nature always wins.