With their agenda so at odds with the preferences of even their own voters, it is no wonder congressional Republicans are focusing their attention on the alleged shortcomings of the Affordable Care Act (ACA) rather than on what they actually propose to do. In order to escape responsibility for the damage they will do to the health system by repealing the ACA, they will try to paint a misleading picture of the law. First, they will entirely omit any discussion of the law’s accomplishments; second, they will advance a series of misleading arguments. That strategy was on full display with House Energy and Commerce Chair Greg Walden’s recent release of an “Obamacare Reality Check.” While repeating opposition arguments isn’t generally good messaging practice, there are a few other significant problems with the “reality check”:

  • Yes, enrollment is lower than originally projected, but that’s partly because fewer employers have dropped coverage than Congressional Budget Office expected. A lot of people would say that is a good thing. And while cost-per-beneficiary is higher than projected, total cost is much lower.
  • Many analysts believe that the premium increases of the past year represent a one-time correction (or would, were it not for the dramatic uncertainty the repeal effort is creating in insurance markets).
  • Also conveniently ignored is the fact that congressional Republicans have actively, and in part successfully, worked to cause premiums to rise by restricting reinsurance payments.

Access to plans has declined in the past year, but repeal will make the problem much worse by causing the non-group insurance market to essentially unravel. Also unmentioned, before the ACA, millions were locked out of coverage entirely because of pre-existing conditions. The lack of plan choice mainly shows up in rural areas that didn’t have a lot of plan choices before the ACA was passed.
Finally, the total cynicism of the Republican attack on the ACA is revealed in their discussion of high cost sharing. Not only do they blame increases in employer plan deductibles on the ACA
(something the law had nothing to do with), but all of their proposed replacement plans rely heavily on high-deductible plans and generally promote skimpy coverage that would make the problem much worse. As former president Bill Clinton said, it takes some brass to attack someone for doing what you yourself are doing.

Looking Before They Leap?

Although so far there is no indication that Republican leaders are rethinking their approach to the ACA, not everyone in the party seems so eager to drive the health care system off a cliff with nothing more than a hope that something will turn up to prevent the fiery crash before it is too late. An increasing number of Republican senators are voicing concerns about the ‘repeal now replace later’ strategy. And some are waking up to the fact that repealing in haste now could make replacing later much more difficult. Of course, voicing concerns is not the same as actually voting against repeal with no replace. Nor should anyone imagine that any of these senators has learned to stop worrying and love the ACA. But just the fact that they are starting to think seriously about the implications of what their leadership is rushing them to do is an important step in the right direction.