Not so fast, GOP — Obamacare won’t disappear overnight

(Opinion) If there’s one thing U.S. Sen. John Barrasso and his fellow Republicans are tenacious about, it’s bludgeoning Obamacare until it finally dies.

With Donald Trump becoming president on Jan. 20, they may actually get their wish. But I don’t think the demise of the Affordable Care Act will be anything like they hoped. I doubt Barrasso will fly back to Wyoming after it happens and be greeted by swarms of grateful people who thank him for thrusting the final dagger into the belly of the beast, finishing off Obamacare so residents don’t have to live in deathly fear of what they mistakenly think is government-run health care.

When the GOP gets through gutting or killing the ACA and replacing it with something it hasn’t figured out yet, it’s far more likely to be a negative experience for everyone involved. When Barrasso bumps into one of the 22,076 Wyoming residents who now have Obamacare coverage, the first thing they’re likely to ask him is, “Why did you get rid of my health insurance?” Expletives could follow.

If I could ask our junior senator a question, it would be based on the knowledge that what became known as Obamacare was actually first proposed by the Heritage Foundation, a right-wing think tank. Conservative Republicans adopted a good share of the plan in 1993. So, senator, would y’all have been OK with it if we had named it “Republicare?”

In 2009 Senate Majority Leader Mitch McConnell (R-Kentucky) said his party’s No. 1 goal was to make Barack Obama a one-term president. Republicans failed, but it wasn’t for lack of trying. Barrasso and Company fought the ACA with everything they could from the very beginning, starting with falsely claiming it would be the start of the dreaded “socialized medicine” Ronald Reagan warned us about.

A lot of Americans bought that lie, giving Republicans the political leverage to stave off the ACA’s passage for two years even though they were the minority party. In fact just about everyone seemed to be upset at the idea of Obamacare, including progressive Democrats angry that Obama gave up on universal health care without a fight. He also wouldn’t go to bat for the public option — a government-run health insurance agency that would compete with private companies — even though it was the centerpiece of his campaign.

The ACA has helped about 22 million people obtain affordable health insurance since 2010, but it’s never lived up to its potential in many states, including Wyoming. Here’s why: At every turn Republicans blocked its chances to succeed.

That’s not an exaggeration, it’s simply the truth. Wyoming played a role in the scheme when our senior senator, Sen. Mike Enzi, in 2009 joined the so-called “Gang of Six” that supposedly tried to broker a compromise plan. But Enzi was warned by McConnell that reaching a bipartisan agreement was the last thing he should do, so Enzi favored changes he had no intention to support when it came to a Senate vote.

After two years Obama got the bill through with much fanfare about how it would be his signature domestic legislation. While it was not the total solution to affordable health care, the reforms added millions of uninsured Americans to the ranks of the insured, which had been a Democratic Party goal for almost the past century.

Read a Pete Simpson Forum essay on the benefits of Medicaid

There are many provisions of the ACA that are extremely popular. They include getting rid of pre-existing conditions as an excuse for an insurance company to reject an applicant, ending the cap on lifetime benefits, ensuring women cannot be charged higher premiums than men and allowing children to stay on their parent’s health insurance policy until age 26. When polled on these issues separately, both Democrats and Republicans strongly support each provision. But when asked if they favor Obamacare, the GOP propaganda machine poisoned the well and a vocal majority still say they hate it.

When the U.S. Supreme Court gave states the opportunity to decide if they wanted to expand Medicaid, a vital part of the new law aimed at enabling the working poor to get insurance coverage, Wyoming immediately said no. In fact, in 2011 the first official act of our new governor, Matt Mead, was to join other Republican-led states to sue the feds over Obamacare’s constitutionality. They lost but that only increased their fervor to kill the law.

The state dithered over whether to establish a state-run health insurance exchange until Wyoming missed the deadline, so our exchange is operated by the federal government. Given the contempt Wyoming politicians have for all things federal, and the state’s insistence that there must always be a waiver for programs so we can do it “the Wyoming way,” why did the Legislature defer to a federally administered health exchange?

Because Wyoming officials didn’t want Obamacare to succeed at any level, that’s why. Waiting so long to design a health exchange and then punting everything to the feds led to a slow start here and the likelihood — which came to pass — that the state would have only a single health insurance provider for a program designed to promote as much competition as possible to keep prices affordable.

That makes the state responsible for Wyoming having the ACA’s highest premiums in the nation, and ensuring low public interest here in the health exchange despite penalties for failing to obtain health insurance.

Trump used the recently announced ACA insurance premium hikes as one of the waves he rode to the White House. He continually called Obamacare a disaster, and the higher costs seemed to give voters in Wyoming a reason to believe him.

Wyoming was the only state in 2013-15 that saw an increase in the number of uninsured residents — the result of officials sabotaging the ACA. But while the average premium hike in 2017 in 40 states and the District of Columbia will be 25 percent, Wyoming will fare much better. The exchange’s premiums through Blue Cross Blue Shield of Wyoming will only go up 7.4 percent.

After subsidies, the average premium for ACA enrollees in Wyoming is just $117 per month. That’s only slightly higher than the national $106 per month average. Despite all of Wyoming’s efforts to negatively spin Obamacare, it is still providing affordable health insurance for consumers here.

Simpson Forum: a view against medicaid expansion

But don’t try to tell Barrasso that. As an orthopedic surgeon who has Trump’s ear, he can now have a large role in convincing the president-elect that Obamacare has to go even as Trump has expressed the possibility he may keep some of its more popular provisions. Last week Barrasso told CNBC, “Don’t get fixated on some of (Trump’s) phraseology. Obamacare is over. We promised to repeal and replace it. And that’s what we’re going to do.”

Barrasso has promised there will be a “smooth transition” to a new system and that no one on Obamacare now will be left out in the cold without healthcare insurance. But how can he make that vow when both Trump and Congress have only vaguely addressed a few elements of what they want their replacement to include? Republicans better come up with a definitive plan that makes sense to the public, or they will have just as much trouble selling their ideas to voters as Obama did.

We know a few things about the future of the ACA. It won’t be replaced for 2017, because there’s not enough time to get another health insurance program in place. Some congressional observers predict the process could take up to two years. It’s also not a given the GOP will be able to pass everything they want, even though they will control the White House and both houses of Congress. Senate Democrats have declared war on Republicans’ “repeal and replace” battlecry.

Democrats can block wholesale repeal of the law through filibusters because Republicans don’t have the 60 votes necessary to end the procedure, which both parties have used when they’ve been in the minority. But the GOP might be able to repeal some portions of the bill through a lengthy, complex budget process called reconciliation, which requires only a simple majority vote and can’t be filibustered. Insurance companies must also be given some time to adjust to the regulatory changes.

As soon as he’s inaugurated Trump will also have the ability to issue executive orders which could change some ACA regulatory provisions without the need for Congress’ approval. He could also quickly appoint a Health and Human Service director who could immediately start writing new rules and regulations for the ACA.

But Republicans will make any changes, especially big ones, at their own peril. If they get rid of Obamacare, they will forever own any health-care problems that result from replacing it. If they are not careful, despite Barrasso’s shaky assurance that no one will lose their health-care coverage, it’s estimated up to 30 million Americans could be affected. Ten million have private coverage through the health exchanges, about 9 million are covered by Medicaid expansion and between 5 million and 9 million people who buy individual policies outside of exchanges are exposed to the volatility of the health insurance market, which in turn is affected by what is happening on the exchanges.

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“I’m expecting big [premium] increases and for the Obama administration to try to hide them all the way through the election,” Barrasso told The Hill newspaper in May. “This health-care law has been devastating to the Democratic Party.”

Obamacare’s GOP-installed replacement could be just as toxic for the next presidential election, if not in the mid-term 2018 congressional elections. It will also be extremely difficult to design with the Democratic interference it will assuredly (and justly) receive. Barrasso and other Republicans have been champing at the bit to score political points off Obamacare since 2010, without even trying to develop a plan of their own. They should be careful what they wish for, because it looks like they’ll get it whether they’re up to the challenge or not.