As the debate over remaking the US health system heats up, I’d like to make a modest request: Let’s stop talking about Obamacare. Drop the partisan, misleading, counterproductive, and increasingly irrelevant hot button label. Instead let’s talk about the pros and cons of what are likely to be some complex and far-reaching changes to the way Americans get their medical care. No more toxic labels.
The very word Obamacare drives policymakers into a frenzy. Yet, it mischaracterizes the current state of the individual health insurance market: Day-by-day, the law enacted in 2010 is already being changed, so whatever it is, it is no longer Obamacare. And the very word forces lawmakers into their partisan corners and makes it impossible for them to design a sustainable, well-functioning system.
Start with the reality: President Trump has already changed the 2010 Affordable Care Act. At the same time, the ongoing confusion produced by the current debate over its fate has changed the market in other, perhaps more important ways. Even if Congress fails to pass any changes to the law over the next couple of months, the individual health insurance market is no longer the market that the ACA created. It is no longer Obamacare.
The new administration has already made enrollment in exchange-based insurance more difficult and, at the same time, weakened the individual mandate for coverage. It has shortened the open enrollment period and made it more difficult for people to buy outside that window. It has also reduced the amount of coverage insurers must provide in middle-tier (sliver) plans, thus lowering premiums but increasing other out-of-pocket costs. At the same time, the IRS will continue to process refunds for filers even if they fail to report whether they have insurance or have paid a penalty for not buying coverage though the original law would have barred those who don’t report from getting refunds.
Then, there is the uncertainty. Not knowing how the law will be changed in the coming months, and afraid of getting locked into a market for which they are unprepared, some insurers have announced they are withdrawing from the ACA program. This will likely accelerate an already-existing trend, result in less competition in some markets, and higher prices.
The result: A new, highly uncertain market for individual health insurance that is hard to define or predict, but which is surely not the same market that the ACA created. Thus, calling what exists today Obamacare misrepresents the reality. For better or worse, the Obamacare we knew from 2014-2016 no longer exists.
Then there is the politics. Just saying the word Obamacare is a conversation killer. It forces Republicans into their “repeal and replace” meme, sharply limiting their ability to seek workable consensus fixes to the law. And it forces Democrats into a defensive crouch, where they refuse to cooperate in any effort that looks like it is repealing Obamacare.
This will leave us with only two outcomes–both bad. Either Trump and Congress will disassemble the law in pieces, without giving much thought to how the whole complex health care organism fits together. Or they will scrap the entire thing in one partisan swipe—mimicking the mistake President Obama made in 2010.
Either way, consumers and providers are likely to be thrown into a cauldron of uncertainty. Already, many Republicans are looking for a way out of this mess. But they are trapped by their own rhetoric as long as the debate is about Obamacare.
Now, imagine an alternative universe. Instead of fighting over whether to repeal or protect a label, sensible lawmakers (and, yes, there are some), sit down with a different goal: to design the best possible health insurance and delivery system. Like any smart reformers, they’d start with parts of the current system that work well, build on them, and fix or scrap those pieces that do not work. One thing for sure: It would be easier and far more productive than fighting over a name.