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The Grim Future for Obamacare

We’ve gone from “Repeal and Replace” to “Repeal and ???”

(Getty Images)
(Getty Images)

About 22 million more Americans have health insurance today than did when Barack Obama took office in 2009, but that could all change very soon. Republicans have vowed to repeal the Affordable Care Act as soon as Donald Trump takes office in January, but their plan to replace it is running into some roadblocks. On the latest Keepin’ It 1600, Jon Favreau, Tommy Vietor, and Jon Lovett talked about why Obamacare is so important and what could happen if it’s repealed.

Listen to the full podcast here. This transcript has been edited and condensed.

The GOP Agrees on Repeal, but Not Replace

Jon Favreau: We’ve gone from repeal and replace to repeal and delay, which is basically just repeal and good luck. Good luck, America.

Jon Lovett: Repeal and go buy some Tylenol.

They’re all over the place [on this issue] but one of the leading contenders for what these Republican professional politicians are going to do is: Repeal Obamacare, not have a replacement, but delay the implementation of [the] repeal until after the midterm elections, which would be the most cynical bit of policy-making we will have ever seen in our lifetimes.

J.F.: And we should we say they’re partly doing this because they know, as we’ve known for quite a while before this election, that the Senate Republicans have a good map in 2018. [So] maybe they have 60 seats after 2018 and then don’t need the Democrats to pass an alternative to Obamacare and [can] just pass it through themselves. So maybe they’re gonna push it off until after 2018.

J.L.: That’s a problem they wish they had because they don’t have a replacement.

J.F.: Well, they have a couple, but they have not agreed on one at all.

J.L.: No, right. They have these different little kind of white papers floating around, none of which are very detailed but all of which would cause people to lose insurance. And they’re terrified of actually getting behind one plan because once they’ve done that, it becomes clear that it has real harm for a lot of people.

Someone Has to Pay

J.L.: One of the problems we have in health insurance is people disconnect the cost that we pay as a society from the cost that they pay themselves. Health care costs money. It’s gonna be paid for. And the question is: Who pays for it? There’s no magic bullet here. If you want to have the government spending much less on health care, that money is gonna come from somewhere, and it’s gonna come from the pockets of regular people.

J.F.: We either have a system where the government pays, insurance companies pay, or people pay.

J.L.: Or companies pay.

J.F.: Right now, exactly. Right now we have all of the above.

J.L.: If you want to make this cheaper for the government, you are talking about shifting those costs to other people or saying that whole swaths of the country are gonna get less care than they need. That’s just basic math and they won’t — and they won’t cop to it.

J.F.: And right now, [about] 22 million people have health insurance who did not have it when Barack Obama became president.

Tommy Vietor: I read this quote from Kevin Brady. It says, “We are not going to rip health care away from Americans.” Yes, you are. You’re just going to do it very painfully and slowly and in the process, you’re going to create chaos in the insurance markets and chaos across the industry where no one is gonna understand who’s enrolled and not, and they have no certainty or ability to set pricing.

J.L.: And even if they were to delay repeal, you’re still signaling to big insurers that this marketplace is going to go away, which would cause them to get out of those marketplaces.

Obamacare Does Have Issues

J.F.: Part of this is, what is the current problem with Obamacare? The current problem with Obamacare is, [no.] 1, not enough states took the Medicaid expansion and decided to reject money from the federal government to cover more of their citizens, most of whom are poor.

And no. 2, costs. The rate of growth of health care costs has slowed down, but people’s premiums themselves have not come down as fast as they need to. So you have to figure out how do we slow the growth of health care costs even more. The solution to both of those challenges is not taking health care away from more people. Or reducing subsidies for people, which is what they want to do. That’s their problem.

T.V.: Or getting rid of the individual mandate that would tax people for not enrolling and getting health care, which was a Republican idea long ago that Obama took and became —

J.L.: Well, after saying Hillary was wrong to do it.

T.V.: Well, yeah, we stole from Hillary, who stole it from Republicans, who stole it from Mitt Romney, I believe.

The organizing principle against ACA has been reflexive opposition to Obama. It will be fascinating to see where these guys go and what policy pieces they chose to support because they are some popular parts — [like] staying on the insurance until you’re 26, not refusing people for preexisting conditions — but those are tied to the unpopular parts.

Democrats Have to Figure Out a Message

J.L.: There’s going to be a lot of distractions. There’s going to be a lot of Donald Trump picking kind of bite-sized conflicts that he can win. This health care issue is gonna have to be the thing we hammer home over and over and over again.

J.F.: We need to run this like a fucking national presidential campaign. Everyone needs to be on board, and we need to have simple messages from the outside.

This is why I was so uptight about this Carrier thing earlier. Because it happened and there were like 35 different messages from Democrats, liberals, progressives, people on Twitter, and it was sort of all over the place and whatever, it’s understandable. It sort of just happened in a couple of days. Whatever. In the grand scheme of things, Carrier is fucking tiny, right, but this health care thing is coming and 20 million people could lose their health insurance. That is an actual tragedy, and then, on the second order, that is a political fight that we should be able to win.

J.L.: And keep in mind, right now, at this moment, a bigger group of people — I think it’s basically exactly 50 percent of the country believes in either Obamacare remaining as it is or expanding it. It is a dwindling small number of percentage — it’s in the [25] percent range that think Obamacare should be repealed outright. So that is an argument that we can win, and I think the key is gonna be figuring out how to talk about this issue and say, “They want to strip healthcare away from people. They wanna privatize Medicare. They want to hurt millions of working people.”

This All Sets Up a High-Stakes Political Showdown

J.F.: And their plan is repeal Obamacare on Day 1 and then say, “[If] the Democrats don’t want work with us to make a replacement for Obamacare, they’re playing politics and it’s gonna be their fault that people lose their fucking insurance.”

T.V.: No one is going to buy that.

J.F.: Well, I’d like to think so. Who knows in this fucking environment?

We need a message. I know we’re out of the prediction game and God only knows what Breitbart and the closed loops of right-wing crazy will say. They’ll probably say that the people who run Comet Pizza won’t put together their own own alternative to Obamacare. But I do think it’s very hard to make an argument that you control the entire government and it’s somehow on the Democrats to put forward a proposal.

T.V.: We should probably start calling it “Trumpcare.” The second they pass repeal, it’s Trumpcare.

J.L.: It is quite possible that we end up in situation where Democrats will have to decide whether or not to filibuster the Republican half-measure to replace the bill. They repealed without a plan, and we’ll be heading toward some kind of health care fiscal cliff because they’ve basically written a crisis into our laws and we need to have a plan for what happens when we’re in that situation.

One Alternative Plan: Medicare for All

J.F.: And hopefully it’s proposing an alternative plan that covers more people, which should be fairly easy.

T.V.: Medicare for all.

J.L.: Maybe it’s time for people to be able to buy into Medicare.

T.V.: Bernie was right.

J.L.: Let’s keep in mind: The only reason right now people 55 and older can’t buy into Medicare is [that] Joe Lieberman single-handedly stripped it out of the law.

I don’t think I’ve [seen] anything in my time in my politics as despicable as that one move. It is usually not possible for single senators to do that much damage. Holy fucking shit.