Welcome to Health Reform Watch, Sarah Kliff’s regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Sarah with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, and read previous columns here.
The Republican plan to defund Obamacare is running into some roadblocks on Capitol Hill. Some Republicans don’t like it. Some really, really don’t like it. President Obama near certainly wouldn’t sign off on it and, even if the government did shut down, it wouldn’t stop the law’s implementation.
So, in other words, there are obstacles to the defunding strategy. And, in general, it’s pretty difficult to stop Obamacare at this point. The law survived a Supreme Court decision and a presidential election, the two events that – had they turned out differently – could have lead to Obamacare’s full-scale repeal.
This isn’t to say that Republicans are completely out of options; there are ways to dismantle or at least disassemble a few pieces of the Affordable Care Act. While they’re certainly not surefire, here are some possibilities currently on the table.
1. Lobby hard against the Medicaid expansion.
Six states, by the Kaiser Family Foundation’s count, have not decided yet whether to move forward with expanding Medicaid under the Affordable Care Act. The Medicaid expansion is a hugely important part of the health-care law, responsible for about half of Obamacare insurance expansion. Without it, the law’s reach dwindles.
Stopping the Medicaid expansion would reduce Obamacare’s reach and create a messaging problem for health law supporters. “How do you explain this in a way that seems fair and reasonable, that the higher-income people get help but you don’t?” said Mike Perry, a founding partner at polling firm PerryUndem Research, told me recently. “Advocates on the ground are really struggling with that group. They want to have a positive message but don’t know what to say.”
2. Convince young, healthy people not to sign up for the law’s subsidies. Or do an enrollment drive with the old and sick.
Don’t raise my premiums, bro. (Mark Gail/The Washington Post)
The White House has made no secret of the crucial role that young adults play in the Affordable Care Act’s success. Their low medical bills, if young adults sign up, would be expected to keep premiums down for everyone else. On the flip side, a marketplace filled with sick and elderly people would have really high health insurance costs.
There’s already some chatter about campaigns to dissuade people from enrolling in the health law’s program, including one that focuses on burning Obamacare draft cards. Some Republican offices say they won’t help constituents connect with the health law’s programs. The pitch to young adults, Obamacare opponents I talk to, would go something like this: Why spend hundreds, maybe thousands, on health insurance coverage when you could simply pay a $95 fine instead?