The GOP’s Grandfather Weapon

Mickey Kaus Columnist
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‘If You Like Your Obamacare, You Can Keep Your Obamacare’: I don’t quite understand the new, near-unanimous Dem line on Obamacare–which is that because it has signed up a few million people, many previously uninsured, it is now somehow invulnerable to repeal. From WaPo:

“A fundamental political shift happened on January 1 because millions of Americans now have health insurance,” said Dan Pfeiffer, an Obama senior adviser. “The Republican strategy now means taking that insurance away. It was all theoretical until now, and the Republican repeal plan is no longer politically viable.” [E.A.]

It may be true, as the New York Times hopefully declared, that “[o]nce a benefit has been bestowed, it is nearly impossible to take it away” (though there are a million or so Americans who’ve been receiving long-term unemployment benefits who might want to argue the point). But there’s a traditional political solution to this Take Away Problem, namely the “grandfather clause.”

It wouldn’t be hard for Republican repealers to write a law that got rid of Obamacare while somehow keeping those few million who’ve signed up on some form of similar insurance. “If you like your Obamacare you can keep your Obamacare.” Exchange policies could be converted to non-exchange policies in a special, no-new-enrollments program, for example. Over time, attrition would whittle this grandfathered class down to trivial size–a process with which you’d think Obamacare’s architects would be familiar.

I don’t know if Obamacare will survive or not. Even its cockiest defenders, now whistling past the graveyard of missed deadlines, concede** that (as one of them, Josh Marshall, puts it) if “the mix of young and old people, healthy and sick” is “significantly out of whack you’ll have problems.”*** Problems that include, in Greg Sargent’s words, the possibility that “insurers pull out, and the exchanges collapse.”

But I do know that if Obamacare isn’t repealed it won’t be because two (or ten) million people in a country of 300 million have already signed up.

P.S.: Its also possible that Obamacare, instead of collapsing, will become a long term, slow-bleeding, painfully unpopular policy wound, as millions more middle class Americans who don’t qualify for subsidies get shunted into the individual market where they have to buy policies that offer them less for more. It’s not clear that this outcome is better, politically, for the Democrats.

P.P.S.: You want a health care benefit that would be nearly impossible to take away, or to grandfather? Extending Medicare to age 55 would have been more or less impossible to take away, even by grandfathering (i.e. by continuing Medicare for existing 55 year olds but denying it to new 55 year olds). Just sayin’.


**– Marshall also downplays the non-payment problem –i.e. the possibility that many of the 2 million who’ve signed up on the exchanges “won’t end up paying their premiums.” He says GOPs who make this argument are “dead-enders” in an “intense form of denial.” But the non-payment threat seems like a reasonable worry for supporters of the law as well as a source of hope for opponents.

***– I favor a more panicked, pro-active approach that accepts the need for reasonably big fixes (e.g. fewer mandatory benefits). Letting Americans know improvements (if necessary) are planned might in turn help build confidence and boost enrollment.