Was it 50 or 60 times the GOP has voted to end Obamacare? With an incoming President who has called the law “a disaster,” the oft-repeated move can now become reality, and the  Republicans own it.  But their move to repeal and, over several years, replace the Affordable Care Act is a recipe for chaos. What they need to do is mend it, not end it, call it Trumpcare, declare victory and go on to some other issue.

No monumental legislation (whether Social Security or Medicare) was perfect in its incarnation. Both examples were works in progress. But Republicans so hated Barack Obama that they adopted as mantra the priority of ending the ACA. Despite its growing pains, Obamacare was a success in the making. According to the most recent studies, fewer than ten percent of the population is now uninsured (Center for Disease Control), an historic low. Contrary to popular myth, the poor are not having difficulty finding doctors (Council of Economic Advisors). Hospitals’ uncompensated care costs have been cut in half as a percentage of operating budgets (Department of Health and Human Services).  The growth in the percentage of GDP eaten up by health care has been declining.

These numbers don’t even include the satisfaction and fright reduction achieved by ending refusal to insure due to pre-existing conditions and allowing young adults to stay on their parents’ policies up to age 26.  Yes, premium costs have escalated for some people in some states, but 85 percent of those individuals are eligible for subsidies.  Are rising costs not a legitimate concern?  Of course they are.  But just as Massachusetts experienced under Romney Care, goal one was to get people insured, then ratchet up cost-saving measures.

The problem is how to achieve cost controls if, instead of increasing the number of young and healthy people insured, the Republican solution is to end the individual mandate for insurance, leaving an actuarial base that is older and sicker.  We expect to buy auto insurance. Why shouldn’t we expect to buy health insurance?  The individual mandate was originally a Republican idea hatched by the Heritage Foundation to avoid a single payer approach.  Now, there’s some evidence that the market for health insurance policies – , including the health insurance exchanges under Obamacare,  – might collapse without the requirement to buy insurance.

Among the possibilities for altering the ACA is to reduce its impact on small businesses, reducing costs by slowing the pace at which subsidies phase out, and finding lower-priced alternatives by raising deductibles.  (Much would be gained by allowing the federal government to negotiate lower drug costs with big pharma.)

Republicans are laying the groundwork for fast-track repeal by working through the budget reconciliation process and also anticipating a series of executive orders. The United States already lags behind other industrialized democracies in its commitment to health care for all.  This move by Republicans, especially the rigid ideologues in the House, reflects the worst of partisan politics inflicting the most harm on those least able to fend for themselves.

Repealing the ACA without having a meaningful replacement is horrifyingly cynical and callous.  And, if that doesn’t bother you, it’s also fiscally irresponsible.  Many costs won’t go away; they’ll just shift. Paradoxically, the Committee for a Responsible Federal Budget predicts that repeal will cost the federal government $350 billion through 2027.  According to The Washington Post, some Republican members of Congress put the cost of repeal as high as $30 trillion.   The numbers are all over the chart, but the message is clear: repeal will cost, and it will cost in dollars and human impact. (Some studies point to lives saved under Obamacare, with health services being delivered at earlier stages of illness.)

Ironically, some salvation for the 23 million who stand to lose their coverage (many in states that supported Donald Trump) may be provided in the unlikely hands of the President-elect who, in a series of tweets and campaign speeches, said he does not want to hurt people. He seems inclined to move more slowly on the idea of outright repeal of Obamacare. What a strange world we live in, when we cling to the ephemeral musings of an incoming President who has called for “replace and replace” rather than “repeal and delay,” who has said that “everyone should have health insurance,” and has even said that government should play a significant role. This puts him at odds with Congressional Republicans, so we may anticipate an intriguing drama with monumental consequences.

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