A year ago, when almost everyone expected the law to expand coverage, there were reasons to doubt it would become popular as a result. Those reasons still apply. A lot of people are going to lose access to their doctors, another round of premium increases is likely, and some employers will drop coverage. Obamacare won’t be responsible in all cases, but it will be responsible in many and blamed in many.
As it becomes clear to opponents that the law is not going to implode on its own, they’ll have to come up with proposals to replace it when they have the power. This is already happening. Last week, Louisiana Gov. Bobby Jindal became the latest Republican to outline a plan.
Some Republicans, however, think proposing their own health-care ideas is a mistake because it distracts from the case against Obamacare. And even those who think it’s important to advance alternatives are divided on a key question: How important is it that a replacement plan increase coverage?
More people would have coverage under Jindal’s plan than under the pre-Obamacare system. But compared to Obamacare, people would lose coverage. Does that matter?
Jindal notes that Medicaid may not improve physical health outcomes for its recipients. Insurance coverage does, however, yield a measure of financial security. For many years, federal policy has suppressed the emergence of a market that would enable almost everyone to purchase protection from catastrophic medical expenses. Undoing those policies — especially by redeploying existing federal tax breaks to help the uninsured — would allow such a market to develop. A proposal by Republican Sens. Tom Coburn, Orrin Hatch and Richard Burr that uses this approach could cover more people than Obamacare does.
The higher-coverage alternative seems like a better bet for the law’s opponents, both from the perspective of winning the 2016 elections and that of actually enacting an alternative. It seems unlikely that Congress would pass legislation to strip coverage from millions of people.