Replacement Conundrum

When I am dead, you’ll find it hard, says he,

to find another man like me.

What makes you think, as I suppose you do.

I want another man like you?

Eugene Ware (1841-1911) , Kansas newspaper man , in He and She

This verse came to mind as I read New York Times articles on Republican plans to replace ObamaCare and Democratic struggles to retain it. Democrats say Republicans will find it hard to replace ObamaCare, but the public wants something different from the old health care law and only the Republicans can provide it.

I reserve Sunday for reading the New York Times to see what it has to say about ObamaCare.

Generally its editorials favor the health law’s continued existence as is , but in the wake of continuing stories expecting the Supreme Court to rule against federal exchanges, its reporters have begun to express doubts about its survival.

The reporters know Republican lawmakers offer comprehensive alternatives, the Congressional Business office estimates federal and state health exchanges subsidies will cost a trillion dollars over the next ten years, and middle class health consumers are reacting negatively to rising premiums, deductibles, co-payments, and out-of-pocket costs, physician shortages, and narrowed networks.

The articles to which I am referring are:

• Robert Pear, “GOP Lawmakers Propose Alternative to ObamaCare,” February 5.

• Robert Pear, “Health Law Case Poses Conundrum for Republicans, “ February 8.

• Elisabeth Rosenthal, “Insured But Not Covered, “ February 8.

The basic conundrum Republicans face is how not to make the ObamaCare replacement cure no worse than the ObamaCare disease, and the puzzle Democrats confront is how to defend an increasingly unpopular law ( 39% approval and 51% disapproval in latest polls).

A Republican Senator, John Barbasso, MD, of Wyoming, explains,

“We want to help people who have been hurt by the President’s illegal actions (federal exchange subsidies), but we don’t want to help this terrible law.”

His Democratic counterpart, Ron Wyden of Oregon, counters,

“ I find it ironic for Republican Senators to argue that the federal exchange subsidies are illegal and then demand that the administration explain how it plans to repair the damage that will be done if their argument is successful and the Supreme Court rules in their favor. It’s like throwing gasoline on a fire, then indignantly asking the administration for its plan to put out the fire.”

The fundamental problem politicians face is what to do with the 6 million or so people who in good faith have signed up and qualified for federal subsidies.

Should the Court rule in their favor, Republicans will have to come up with a contingency plan allowing consumers to keep their subsidies during a transition period. The GOP will come under pressure to from constituents , hospitals, and insurers to replace the subsidies with something that doesn’t leave people out in the cold hard world of the uninsured.

Which leads to this verse.

Dems will claim ObamaCare is irreplaceable,

For humane reasons it is virtually unerasable.

The GOP will say subsidy costs are inconceivable,

One trillion dollars, that's simply unacheivable.