It is unknowable whether President Barack Obama produced an American consensus in favor of a government obligation to guarantee universal access to health insurance, or whether the debate surrounding the ACA merely catalyzed a gradually forming consensus. In any case, today’s debate about replacing the ACA is occurring in the context of that consensus. And in the context of several other new beliefs: Health insurance should not be denied because of an applicant’s preexisting medical conditions. And federal law should provide a refundable tax-credit entitlement and require that children up to age 26 be eligible for coverage under their parents’ insurance.
Furthermore, Republicans are insufficiently radical as they largely accept this third-party payer system that distorts decisions about recourse to the health-care system: About 180 million Americans are covered by employer-provided insurance, which is not taxed as what it obviously is — compensation. Republicans have abandoned a measure to treat as taxable income a small portion of the most generous employer-provided insurance plans, and have postponed for a nearly decade — meaning, probably, forever — the “Cadillac tax” on such plans.
Given all this, it is probable that whatever replaces the ACA’s tapestry of subsidies, regulations and mandates will be a tapestry of subsidies, regulations and mandates. The differences probably will constitute substantial improvements but will hardly constitute a revolution in the relation of the citizen, or the health-care sector, to the government.