Dump health law? Not so fast, Congress

Miami Herald Editorial Board

GOP Rep. Tom Price, a foe of Obamacare, is the nominee to lead the Department of Health and Human Services.
GOP Rep. Tom Price, a foe of Obamacare, is the nominee to lead the Department of Health and Human Services. Bloomberg

Elections have consequences. It’s no surprise that President-elect Trump wants an ardent opponent of Obamacare, Rep. Tom Price, R-Georgia, to head the Department of Health and Human Services. He wants followers to know he’s serious about getting rid of the outgoing president’s signature law.

But anyone expecting that “repeal and replace” will be easy, now that Republicans control the government, is bound to be disappointed, especially if Mr. Trump was sincere when he said — after the election — that he wants to keep some of the law’s most attractive features.

For years, Republicans have tried to sabotage the Affordable Care Act by any means possible. House Republicans have voted at least 60 times to kill the law. Sabotaging a law doesn’t take legislative skill; it merely requires a party marching in ideological lockstep to defy a president they never liked.

But now that a Republican president will be in the White House with a GOP-majority Congress, Republicans will have the burden of governing. They — and the incoming president — will find that crafting thoughtful legislation, if that’s what they truly want, to improve the lives of Americans is harder than sending out a tweet.

On the one hand, Republicans in Congress want to scrap Obamacare, simple as that.

On the other, Mr. Trump now says he wants to keep the part of the law that prohibits insurance companies from discriminating against people with pre-existing conditions. And he also likes the provision that allows parents to keep grown children on their policies until the age of 26.

Mr. Trump seems to understand the paradox of the healthcare law: “Obamacare” has become a code word for big government and is thus disliked by many, yet millions have benefited from the law and will demand a replacement that satisfies its basic intent: to improve health insurance markets and ensure that Americans can’t be denied coverage for any reason.

Salvaging this and other essential provisions while scrapping Obamacare would be the legislative equivalent of squaring the circle. There is no clear path to “repeal and replace” because Republicans have never bothered to sit down with Democrats to figure out how to improve the law that everyone, including President Obama himself, concedes is far from perfect. That would have required bipartisan compromise, which was never in the cards as long as Mr. Obama was in the White House.

Much ink has been spilled to publicize the law’s defects. The most glaring: Prices are higher, and choices are fewer. And though most enrollees are satisfied with the law, the approval rate is declining.

But that does not overshadow the law’s accomplishments. Its essential functions are working as intended. More than 16 million Americans have gained health insurance. There are no annual or lifetime limits on healthcare. You can’t be charged more based on health status or gender. Subsidies are available for most of those who need it. The increase in medical costs has slowed. Medicaid eligibility has been expanded in 26 states (not Florida, though). Not to mention those other provisions that Mr. Trump says he favors.

It would be cruel, not to say politically risky, to get rid of these healthcare protections for millions of Americans without having a practical alternative in place. That will be Rep. Price’s challenge if he becomes HHS secretary. We wish him all the luck in the world. He’ll need it.