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February 10, 2014 at 08:29 AM
(Bloomberg) — Those interested in the future of health care reform should definitely check out Andrew Sprung’s “what if?” piece on what Republicans would actually do if they had the chance after 2016. Sprung talks to three economists to get a sense of it. It’s an outstanding article.
The first thing to note is that repeal is, in fact, dead. There’s simply no way to go back to the status quo ante. And in fact, hardly anyone would want to, including conservative policy wonks.
What I took away from the piece, however, was a bit different than that. It was that Republicans may be constrained by their own rhetoric into framing whatever they would want to do to improve (from their point of view) the new system as “repeal” and replace, even if the replace part of it basically just revives the things they are repealing.
In other words … no one is going to simply shut down the exchanges (at least in the states where they are working, which will likely be the overwhelming majority of the states). No one is going to push young people off of their parents’ plans (or, to be more precise, allow insurance companies to do so). The Affordable Care Act was a large and complex law; there are all sorts of provisions in there that people now rely on and plan around, and for the most part no one is going to want to cause the disruptions that pure repeal would produce.
And yet there are quite a few conservative reforms which could certainly build on the structure that’s now in place. Some of those reforms, as Sprung details, many liberals and liberal policy experts would be perfectly happy with. Some others wouldn’t actually work well in practice, regardless of their rhetorical repeal. But the point is that a serious Republican Party would have an active health care agenda. It just won’t (really) involve eliminating the ACA, just as the ACA itself didn’t eliminate lots and lots of previous reforms and policies.
