There are other reasons to worry. As I’ve noted before, Obamacare is on life support, requiring regular cash transfusions of dubious legality, and insurer-friendly regulatory rulemaking, to keep the exchanges even in their current parlous shape. If the new administration stops being so helpful, even if it makes no change in the law at all, there’s a good chance that insurers will pull out, and the death spiral will enter the point of no return.
And that’s before we come to the shambles in Republican health-care policy-making right now. Trump has nominated Tom Price to head the Department of Health and Human Services. He is a conservative reformer who wants to cap the tax advantages of employer-provided benefits, and tilt the market toward consumer-driven health care with the use of medical savings accounts. He also would offer smaller but broader tax credits to help people buy insurance, and deal with the problem of the uninsurable by creating high-risk pools. You can argue about whether this is good policy, but at least it’s a coherent vision.
Unfortunately, it doesn’t seem to be shared by our future president, who repeatedly fumbled even basic sound bites on health care during the campaign, and has suddenly started promising that we’re going to have insurance for everyone. (Details to come later, he says.) And congressional Republicans seem to be careening toward repealing whatever bits of Obamacare they can in order to put a win on the board, even if the bits that are left inexorably destroy the individual market for health insurance and leave us worse off than we were before.
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