Ever since the November election results, GOPers have been trying to figure out how to follow through on their many, many promises to repeal Obamacare without immediately taking health insurance away from the tens of millions of people who have obtained it via the Affordable Care Act’s insurance-purchasing exchanges or the expanded Medicaid program. Some favor a two-year delay of the effective date for an Obamacare repeal, and others a three-year delay. There’s even talk of a delay to put off the consequences of an Obamacare repeal until after the 2020 presidential election.
Now comes the American Enterprise Institute’s conservative health wonk James Capretta with an idea that cuts to the chase: Why not just “grandfather” all the people currently receiving benefits via the ACA and make whatever the new “replacement” system turns out to be prospective for new people seeking assistance?
Over time, there would be a natural transition from the ACA to the replacement plan. A transition of this kind would mean allowing all persons who are now enrolled in an insurance plan offered on the exchanges to continue to be eligible for those plans, with premium subsidies provided under the rules of the ACA. It would also mean allowing all those who became eligible for Medicaid because of the expansion of the program in the ACA to stay enrolled in the program, even if a replacement plan eventually lowers the income eligibility levels for prospective Medicaid applicants. Allowing people to keep what they have today on an indefinite basis will help stabilize the marketplace and allow for an orderly, rather than a chaotic, transition.
There are two basic problems with the idea. The first is that limiting Obamacare benefits to people already in the system is as arbitrary as terminating the benefits immediately or two or three or four years down the road. The second is trying to sell this to conservatives as an actual “repeal.” It sure would not generate the kind of federal budget savings Republicans have been drooling over as a byproduct of repeal.
It is also worth noting that Republicans have not had much luck in the past convincing people to accept radical policy changes by grandfathering those most immediately affected. George W. Bush’s proposed partial privatization of Social Security was supposedly only going to affect people aged 55 or younger. The same was true of Paul Ryan’s original Medicare voucher proposal.
It is true the idea has the advantage of being relatively simple and predictable, even if, as Jennifer Rubin acerbically noted, the rapidly backpedaling GOP might as well just admit it’s not repealing anything until it’s got its act together on a replacement plan.
Until the GOP can pass something that garners bipartisan support and solves the Obamacare problems it has identified, it should do nothing. That’s the ultimate “grandfathering” — leave the system in place. That is the only real solution politically or policy-wise that doesn’t create a raft of victims. The sooner the GOP figures this out, the better.
But, but, but — who will tell the base?