x-post from fbook. Sorry to the six of y'all who see this twice.
I've been thinking about Trump's election and the Affordable Care Act. During the debates, Clinton said that we should, "keep what works and reform what can be made better." Trump said that he planned to "repeal and replace" Obamacare.
First, after 6 years or so working in health insurance, starting around the time the first regulations of the ACA took effect, I can finally say, within the past couple years, that people, for the most part, know a few of the good things that the ACA provides. Children can stay on their parents' healthcare through age 26. Insurance can't be denied for pre-existing conditions. Minimum preventive care is provided for free. People might not understand the minutiae of the law, but they're going to understand if someone in their family goes from being covered to not being covered, and they're going to blame whoever made the change.
So, when the two candidates say "keep...and reform" vs. "repeal and replace", they're mostly agreeing on what's going to stay in place. It SOUNDS like the Republicans want to repeal Obamacare and then try to figure out a new healthcare package that puts the good parts back in without the bad parts, but really, who benefits from doing it in that order?
The social media posts I've seen from liberals discussing the inevitable repeal seem to be asserting that Trump is just going to "do whatever the insurance companies want."
This sort of implies that insurance companies hate Obamacare. Insurance companies are making money by having 20 million more people enrolled in insurance. The people that got insured under the ACA who weren't insured before were mostly young, healthy people. Those people are money-makers for the insurance companies. I haven't researched extensively, but from what I've read, profits are up in the insurance industry.
You know what cuts into those profits? Administrative costs. Shifting divisions of the company around to accommodate a major change in national healthcare policy cost the insurance industry a lot of money. Changing it is going to cost more money. Repealing the current system and then changing it AGAIN when the new law gets passed is going to cost even more. The insurance industry has no desire to see the ACA repealed without a replacement already in place. The plan they eventually come up with is probably going to look suspiciously similar to what's there now, but with different names on the bill.
So, what's the part of the Affordable Care Act that people actually dislike? Individual mandates. The requirement that everyone has to hold a healthcare policy that meets certain minimum standards of care. They're mad that small business owners (mostly imaginary ones) are going broke paying for health plans for their employees, and some people have to pay a tax penalty for not having coverage.
But, that's what pays for all the good parts people want to keep, and are gonna be mad about losing, and vote every John Q. Whitemale out of Congress if it goes away. Lucky for us, there's nothing that Republicans do better than NAMING STUFF. The beauty of "Obamacare" is that it's a catchy name that people recognize even if they don't know what it means. The people who voted for Trump don't hate the product; they hate the brand.
So, the Republicans can pass some healthcare legislation that replaces all the important parts of the ACA, but call it The Bootstrap Wellness Rodeo or whatever nonsense they decide on, and the world spins on.
This is just conjecture on my part, but I honestly don't it working out any other way.
tl;dr: All of you who said the ACA was a half-loaf compromise forced on us by insurance lobbyists were sorta right, and that's why it's not going anywhere.