While it appears that the Affordable Care Act is under grave threat as the Donald Trump administration prepares to take office, those who fear the worst should take solace in the fact that Republicans have no plan to replace it and face a political quagmire if they boot millions of Americans off their insurance plans.
Having promised to repeal Obama's signature legislative accomplishment "immediately", Trump and the GOP are beginning to understand that repealing it and replacing it is going to be, well, politically impossible.
The simple fact is, the ACA is working quite well, and millions of Americans will lose their healthcare should they repeal it with no working model to replace it. While there are certainly problems with Obamacare, as the Boston Globe reported the legislation brought "historic increases in coverage for low-wage workers." The National Bureau of Economic Research also found that medical debt for those covered by Medicaid expansion under the new legislation "dropped by between $600 and $1000 per person." The fact that Americans can also no longer be denied health insurance due to preexisting conditions, the combination of increased coverage, increased benefits and radically reduced risk of going bankrupt due to medical bills makes Obamacare the modern political equivalent of social security -- a program Republicans have failed to dismantle despite decades of fear mongering.
Americans tend to notice benefits when they are taken away from them, and the prospect of going back to the completely unregulated mess we had during the Bush years will be enough to cause major social upheaval. If Trump thinks the reaction to his misogyny was extreme, he hasn't seen anything yet. There is absolutely no doubt that Americans will take to the street until Trump backs off his plans to dismantle the ACA, and the GOP instinctively understand this. That is why they have been sending mixed messages about what they will repeal, and when. While hardliners are determined to get rid of it straight away, Trump knows this is politically impossible and has been busy distracting his supporters with tweets like this:
While Trump should never be taken at his word (particularly on twitter), his last statement that "It will fall of its own weight" is an indication he plans to do absolutely nothing about Obamacare once in office. In every scenario you can imagine, repealing the ACA is politically toxic for Trump and the GOP.
Should they repeal the ACA with no real alternative, Republicans would have hell to pay in the midterms in 2018. If they wait till 2018 to get rid of it with whatever back up plan they come up with, the risk is again far to high given Trump will have to start running for re-election the following year. Any GOP backed plan will be devastating to the poor, and Trump needs them if he wants any chance of getting re-elected in 2020.
The political consequences of not dismantling Obamacare are actually relatively benign for the Trump administration. Trump lied about everything anyway, so his supporters won't care one way or the other. As long as they still get their health care and have their guy in the White House, they won't mind too much. The cost to the GOP might be significantly more painful given they have based their entire existence on opposing Obamacare, and given they have shown absolutely no willingness to stand up to Trump, they'll have to grin and bear it. The Democrats will have a field day exposing their cowardice and may well benefit in the midterms.
While the prospect of the ACA being repealed is still real, Democrats have much to be hopeful about. Republicans are now in charge and will face the reality of owning everything they do. Given their astonishing incompetence, the Democrats stand to gain from virtually every scenario imaginable. If Trump goes through with the repeal early, Democrats gain in the midterms and can block far more of his ludicrous policies thereafter.. If he repeals late, he'll almost certainly get ousted in 2020. And if he doesn't repeal at all, Americans get to keep their health care.
Welcome to the real world, Donald. You can't tweet your way out of this one.
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