Republicans would seem to have the upper hand with regard to Obamacare. Almost everything they said during the debate has proved true.
The Class Act provision was not viable and had to be stricken from the law. Premiums did not go down as predicted, but in fact increased dramatically. A few major insurers have indicated their intention to withdraw from the medical insurance market, notably in California. The medical device tax is a lightning rod, drawing opposition from both sides of the aisle. The restrictions against high deductible major medical plans has encouraged employers to cut employees to part-time status, limit workforces to avoid the mandates that kick in at 50 employees and opt to pay the penalties rather than offer insurance. The 1099 reporting requirement for businesses proved overly burdensome and had to be repealed. Time and time again, the opponents of Obamacare have been proved correct.
Most of this was not rocket science. Still, Democrats continued to argue positions that they knew would be proved wrong in short order. Even now, they seem remarkably stoic as the whole program appears to be teetering on the verge of destruction. Why? The answer is they didn't care if the bill was impractical or unsustainable. They needed a bill more than they needed one that worked.
This is perhaps the one and only time that the conspiracy theorists were proved right. The Democrats promoted and passed a predictable catastrophe. It now falls to Congress to fix it. And the only plausible fix for a catastrophe of this scope is single payer.
Republicans have launched a number of mostly symbolic efforts to repeal Obamacare. Why doesn't the repeal effort gain traction? Setting aside the obvious (Democrats control the Senate), my question is "If public sentiment is truly against Obamacare, what does the public want Republicans to do? They are clearly not hungering for the 39th or 44th version of a repeal that can't pass.
Obamacare is the law now. It has beneficiaries and the Republicans need to replace Obamacare with something beyond simple repeal. Let me suggest the following:Republicans should propose a suspension or repeal of Obamacare, pending the passage of a more thoughtful, less complex and viable replacement. Eighteen months would be a reasonable time frame; sufficient to fashion a bipartisan alternative. If that is not possible, Republicans can head into 2016 with an actual Republican alternative on the table.
In the interim, taxpayers should be to allowed to deduct all out-of-pocket medical expenditures directly from gross income, reducing the individual's tax burden even if he/she takes the standard deduction. This would return tax dollars to him/her that could be applied toward the purchase of insurance, medications or the direct purchase of medical devices or services. This would further encourage people to purchase the insurance coverage appropriate for their individual age, risk profile and financial capability. Those who choose to remain uninsured will be able to reduce their gross income by the amount of their non-insurance related medical expenditures. All medical expenses will be paid for with pre-tax income.
Some provision must be made to fund Medicaid shortfalls. There are several options here as there are funding sources for Obamacares that might be diverted for this purpose. One such example would be the the 3.8 percent tax on unearned income from dividends, royalties and partnership income levied against those making $250,000 a year.
You can't repeal and replace Obamacare with nothing. We are past that point. This reform, however would resolve the issue of who is in charge of an individual's healthcare and would provide the market an incentive to provide the widest possible array of products, from long term care to major medical as well as comprehensive care.
If Republicans want to repeal Obamacare, they need to own the fix. This would be a good place to start.