Regardless of what you think about Hillary Clinton, President Obama, or centrist Democrats in general, there is no question that they would not repeal massively complex legislation affecting millions of people without a comprehensive backup plan. While the Democrats are (sometimes fairly) criticized for being beholden to corporate interests, they are at the very least grown ups with a sense of responsibility towards the people who voted for them.
The Affordable Care Act itself was painstakingly formulated, planned and enacted so that it would cause minimum damage to American citizens. The role out wasn't perfect by any means, but it eventually worked and now millions more Americans have affordable health care. In fact, the rate of those without insurance is at a historic low, and the most vulnerable people can now get health care without worrying about going bankrupt.
The Republicans however, have spent the past 8 years promising to repeal all of Obama's signature legislation and replace it with, well, who knows? According to the GOP Obamacare was bad in every way and they hated it with a passion. But now it is time to follow through on their promises, Donald Trump and the GOP have absolutely no clue what to do. There is no back up plan, and millions of Americans will lose their health care if they follow through with repealing it.
As Paul Krugman points out, Obamacare legislation was very well crafted, and was designed to keep costs low through the individual mandate. 7 years ago, Krugman explained the logic:
Start with the proposition that we don’t want our fellow citizens denied coverage because of preexisting conditions — which is a very popular position, so much so that even conservatives generally share it, or at least pretend to.
So why not just impose community rating — no discrimination based on medical history?
Well, the answer, backed up by lots of real-world experience, is that this leads to an adverse-selection death spiral: healthy people choose to go uninsured until they get sick, leading to a poor risk pool, leading to high premiums, leading even more healthy people dropping out.
So you have to back community rating up with an individual mandate: people must be required to purchase insurance even if they don’t currently think they need it.
But what if they can’t afford insurance? Well, you have to have subsidies that cover part of premiums for lower-income Americans.
This is exactly what Obamacare does, and there is no other way to get people insured while keeping costs to a minimum, unless of course Republicans want to enact a single payer model -- which of course the don't. Wrote Krugman today:
It’s actually amazing how thoroughly the right turned a blind eye to this logic, and some — maybe even a majority — are still in denial. But this is as ironclad a policy argument as I’ve ever seen; and it means that you can’t tamper with the basic structure without throwing tens of millions of people out of coverage. You can’t even scale back the spending very much — Obamacare is somewhat underfunded as is.
Will they decide to go ahead anyway, and risk opening the eyes of working-class voters to the way they’ve been scammed? I have no idea. But if Republicans do end up paying a big political price for their willful policy ignorance, it couldn’t happen to more deserving people.
As I have argued before, Trump and the GOP are completely screwed whatever they do. If they repeal, they pay a huge political price either in the midterms or in 2020, and if they don't repeal it, they will be viewed as incompetent liars. My guess is that Trump is so shameless that he will probably keep the ACA and try to pass it off as his own -- which is still a win for millions of Americans who will get to keep their healthcare. Either way, Republican voters are now going to see just how badly they were lied to, and the GOP is going to pay a very, very heavy price for their deceit and hubris.