Every once in a while a dog catches a car — and it seldom ends well for the dog

Signing Obamacare
President Barack Obama signing the Affordable Care Act, AKA Obamacare

| On Tuesday, the electorate chose Donald Trump to be the next president of the United States, sending shockwaves around the world and leaving pundits and late-night comics alike grasping and gasping for something to say. On Wednesday morning, half the population woke despondent, depressed, even fearful.

The big question facing everyone is, Now what? If Hillary had won, we might not have like it, but thanks to her basket of plans and positions we would have known pretty much what she would try to do as president. But Hillary didn't win; Donald Trump won. He ran a content-free campaign in which he said whatever came to his mind, which often conflicted with something he had said the day before, or even earlier in the day, or just a few minutes ago. He has no political experience whatsoever. The truth is noone has any idea at all what he really believes in, probably even Donald Trump himself, if he indeed has any reasoned beliefs at all.


Ever since the Affordable Care Act was signed into law, the Republicans have made "repeal and replace Obamacare" a foundational plank of their platform. The "repeal" part always got more attention than the "replace" part. At no time did the Republicans ever come up with a replacement plan. The House voted 50, 60, who knows how many times to repeal the act. At one point they managed to get a bill through both the House and the Senate that would have repealed significant parts of the law, but it was vetoed by President Obama. The various presidential candidates all vowed that getting rid of Obamacare would be part of their "day one" agenda, and Trump joined in the chorus.

Supposedly Obamacare was despised by the populace. Supposedly it was a job-killing law. But since it was signed more and more jobs have been added to the economy and 20 million or so people now have health insurance who did not have it before.

Article on NYTimes home page
Home page of NY Times, Nov 11, 2016

But, a funny thing happened the day after the election — a hundred thousand people signed up for Obamacare!

A reasonable interpretation is that people want to get "grandfathered in" before Republicans take an axe to the law. And we know very well what they would like to do. We have only to look at the bill that passed both the House and the Senate:

Last year, the Senate passed a reconciliation bill that undid large portions of the health bill. The House passed it. And President Obama vetoed it.The bill would have eliminated the expansion of Medicaid coverage for Americans near or below the poverty line. It would have eliminated subsidies to help middle-income Americans buy their own insurance on new marketplaces. It would have eliminated tax penalties for the uninsured, meant to urge everyone to obtain health insurance. And it would have eliminated a number of taxes created by the law to help fund those programs. (It was written to kick in after two years, meaning the programs would not disappear immediately.) Many parts of the law cannot be repealed through reconciliation. Among them: reforms to the Medicare program, a provision that requires insurers to cover young adults on their parents’ policies, and requirements that health insurers sell policies to anyone regardless of their health history. Those parts of the law are very likely to remain law.Crucial aspects of the bill can be undone in a number of other ways, too. The administration could simply halt efforts to sign people up for the state marketplace plans. Or Congress could eliminate the federal subsidies that help millions of people afford a plan. Either one of those moves would most likely cause far fewer people to sign up for insurance, leading to instability or collapse of the insurance marketplaces.

While Obama is president, the Republicans could take votes to repeal until their hearts were content, knowing that they could safely score points with their base because they knew they would never have to pay a price, to pay any consequences. Any bill getting through both houses of Congress would certainly be vetoed by Obama.  But what about when Trump is sitting at 1600 Pennsylvania Ave? He has said he would sign such a law. Will lawmakers be willing to throw 20 million people to the wolves?

And what about the insurance companies? They got a lot of new customers because of Obamacare — will they be willing to blithely give them up? According to the CEO of Aetna, they were so sure Trump would not win that they made no contingency plans to deal with the possible repeal of ACA.

What about the hospitals? Will they be prepared for the deluge of uninsured people in the emergency rooms?

What's going to happen? Nobody knows.

Multiply this uncertainty by the number of significant issues facing the country. It's going to be a very rocky future. We have truly fallen off the edge of the world. Silly us, we thought it was round!

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Last updated on Apr 13, 2018



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