In the first seminal battle between the emboldened Trump-backed GOP Congressional majority and outnumbered Hill Democrats, the Obamacare repeal battle will see both sides employing a carefully nuanced messaging strategy.
Senate Minority Leader Chuck Schumer has opened the show by mockingly declaring “Make America Sick Again” the mantra Democrats will employ to club Trump and Hill GOP.
But despite the headline-driving Schumer sloganeering, Politico Pro Health presciently points out the real message battle will involve a more substantive policy discussion surrounding “universal coverage” versus “universal access.”
Subtle difference; enormous policy implications.
Among the foundational premises of the Affordable Care Act (ACA) — a.k.a. Obamacare — was that the law would provide insurance coverage for every American. While more Americans are indeed insured since becoming law in 2010 — surely a positive development — the objective of “universal coverage” has failed badly, as premiums and deductibles have risen sharply for millions of Americans. Obamacare backers will continue to embrace the need for universal coverage, and that ‘tweaks’ in the law — and more time — are necessary.
Trump and the GOP, meanwhile, will wrap their repeal effort around the concept of “universal access” — meaning the objective will be to ensure every American can attain coverage, but at a price point significantly lower than the widespread, status quo spikes in premiums and deductibles.
Implicit in the GOP approach will be the need to re-examine how high-risk populations with severe, chronic health problems will be cared for. This cannot be swept under the rug. Health Savings Accounts (HSAs) and establishing high-risk pools — generally derided by Democrats — must be part of the answer.
Yet, with less regulation, no individual or employer mandates, and a free market approach, Republicans believe they can design a system that prioritizes affordable plans “so people can get the care that they need, not coverage, but the care that they need from a doctor they choose at lower costs,” said Sen. John Barrasso (R-Wyo.), who will play a significant role in repealing Obamacare.
Democrats view this as an ideological fig leaf for a new health care experiment, and are already trying to stoke a revolt against repealing the ACA — in their view one of the biggest domestic policy accomplishments since Medicare and Medicaid.
Says Sen. Chris Murphy (D-Conn.): “The votes in early January are simple: Do you want to go back to the days when 20 million people didn’t have insurance and insurance companies were running our health care system? Or do you want to fix what we have?”
“Fixing” what we have is largely rhetorical sleight-of-hand, as any ‘fix’ will require additional resources, additional time and still more patience. GOP repeal-backers believe Democrats have pursued the wrong healthcare reform goals — and are stuck, culpable for failure, and playing a losing hand.
President Obama made three original promises: you can keep your doctor, keep your insurance, and costs would be reduced.
All three are demonstrably false.
The Obama administration’s single-minded focus on universal coverage rather than access to affordable care is the same as a football team celebrating all the yards it gained while losing the game.
“There’s a huge difference between having an insurance card you’re required to carry, and having access to quality health care you can use,” said one ACA repeal supporter.
That’s exactly right.