In a recent letter to their fellow senators, Senate Minority Leader Chuck Schumer, D-N.Y., and Sen. Bernie Sanders, I-Vt., argue that public support for Obamacare is "at an all-time high," and that "the overwhelming majority of Americans want to improve the ACA, not destroy it."
They seem to be basing their claim on a recent poll showing that 45 percent of Americans believe that Obamacare was a "good idea" -- the highest approval rate since the law's enactment.
Does this mean that public opinion is turning against the GOP's efforts to repeal and replace Obamacare? Not in the least. Asking Americans to give Obamacare -- a complex, 2,700-page law passed without a single Republican vote in March 2010 -- either a thumbs-up or a thumbs-down reveals little useful information. The same goes for public attitudes towards "repeal and replace" in the abstract.
What matters are Americans' views about particular, concrete policies -- what's actually in a healthcare reform package. And as a recent survey by the American Action Network shows, the individual components of House Speaker Ryan's "A Better Way" plan have widespread public support. This bodes well for the repeal and replace legislation that Speaker Ryan has promised to introduce shortly after Congress returns from its recess on February 27.
The American Action Network's January poll queried 1,000 Americans split evenly across party lines. An overwhelming majority of respondents -- 63 percent -- voiced support for a GOP replacement similar to Ryan's plan.
Public opinion on individual reform measures is even more encouraging. Consider the system of age-based refundable tax credits for subsidizing insurance favored by both Speaker Ryan and new Health and Human Services Secretary Dr. Tom Price. Americans could use these credits to buy the plan of their choice on the individual market -- and put whatever they don't spend in a tax-advantaged Health Savings Account.
Nearly 76 percent of Americans support a subsidy scheme of this kind.
The poll also reveals strong public support for ending Obamacare's costly insurance-market mandates. The Affordable Care Act requires all plans in the individual and small-group markets to cover a list of "essential health benefits," which include everything from maternity care to speech therapy and pediatric dental care. By forcing insurers to cover a wide range of procedures and services that many customers don't want or need, the law all but eliminated low-cost insurance options.
It's no wonder, then, that 73 percent of Americans want to see these mandates repealed.
Sixty-five percent support giving consumers the freedom to buy insurance across state lines. More than three-quarters favor Medicare reforms that provide "seniors with the right to choose between buying private insurance or traditional Medicare."Both are central features of the healthcare reform visions of Ryan and Price.
One aspect of Obamacare that remains popular is the law's so-called "guaranteed issue" rule, which prohibits insurers from turning away customers because of pre-existing conditions.
Unfortunately, guaranteed issue is one of the reasons that premiums and deductibles have skyrocketed under Obamacare. After all, if customers can wait until they get sick to purchase coverage, why pay premiums when they're healthy?
That reality has left the insurance risk pool disproportionately comprised of costly, less-than-healthy individuals. Insurers have had to raise prices to cover the cost of these folks' care. Those price hikes have in turn prompted an ever-increasing number of reasonably healthy people who may want to stay covered to go without. And the process repeats.
As a result, many of the major insurers cut back on exchange coverage this year. Last week, Humana announced that the company would not participate in any exchanges next year. Molina Healthcare’s CEO announced that the health insurer lost $110 million on its exchange plans, even though it expected a 2016 profit of $60 million from the marketplaces. That company has refused to commit to participation in the exchanges beyond this year. And Aetna's CEO Mark Bertolini admitted last week that Obamacare is in a "death spiral.”
Fortunately, Republicans have a way to provide security for Americans with pre-existing conditions without sending insurance prices into the stratosphere for everyone else. Both the Price and Ryan plans prohibit insurers from raising prices because of a medical condition so long as the individual has maintained continuous coverage.
This approach encourages individuals -- including the young and healthy -- to get covered and stay covered.
The American people should be receptive to Republicans' case for reform. As the American Action Network poll makes clear, when presented with a detailed conservative alternative to Obamacare, an overwhelming majority of voters are onboard.
Yet the GOP has thus far failed to coalesce behind a Ryan/Price-style reform package. Instead, Republican lawmakers have engaged in a messy debate resulting in a chaotic mix of proposals and messages.
Some factions are arguing for immediate repeal, replacement plan be damned. Others want to delay the replacement to some undetermined point in the future. Still others favor "repeal and repair" -- which is not repeal at all. Sens. Bill Cassidy, R-La., and Susan Collins, R-Maine, have offered a plan that would allow states to keep Obamacare if they wanted to. And President Trump has promised to provide insurance for everybody -- details to be determined.
Fortunately, the work of uniting behind a single vision for repeal and replace is finally underway. Judging by the policy brief from last week's meeting of House Republicans, lawmakers are moving forward with a reform very similar to Speaker Ryan's "A Better Way" plan. The document proposes tax credits for subsidizing insurance as well as expanded health savings accounts, but leaves out reforms allowing Medicare beneficiaries to purchase private coverage.
The process of finalizing and passing this legislation needs to happen fast. Americans strongly support a full-scale repeal and replacement of Obamacare in line with Speaker Ryan's vision. Republicans shouldn't keep them waiting any longer.
