Governors in Washington over the weekend for the National Governors Association meeting saw a sobering presentation from consulting firms Avalere Health and McKinsey & Co. about the possible effects repealing the Affordable Care Act (or Obamacare) might have on their states. In the presentation, preliminary analysis suggests over half the people in some states who don't have heath coverage through their employers might no longer be able to afford it.

The analysis looked at two hypothetical states, one that had expanded Medicaid under Obamacare, and one that had not. In the state with expanded Medicaid, 30 percent of people without employer-provided health insurance would no longer be able to afford coverage. In the hypothetical state that had not expanded Medicaid, just over 50 percent of those without employer-provided insurance would no longer be able to afford it.

The consultants were careful to say that the findings should not be extrapolated to create national estimates, and that with health care laws and proposals in play, it is difficult to predict how many people really will or won't lose coverage under a new Republican replacement for Obamacare. And a McKinsey executive told Bloomberg she had based her research on a detailed plan proposed by Tom Price before he became secretary of Health and Human Services--a logical choice given the reasonable presumption that Price got the job because of his plan. Given that the states all have different situations, and that unknown factors such as high-risk pools where insurers would be forced to provide at least some level of insurance to those with poor health might reduce some of the drop-off.

Governors, perhaps predictably, responded along party lines. Washington's Democratic Governor Jay Inslee worried about tens of thousands losing health care in his state, saying, "We're going to have to make sure that does not happen." On the other hand, Kentucky's Republican Governor Matt Bevin commented that "simply enrolling people serves absolutely no value if all we've given them is a plastic card that says you're now covered. They take that to a doctor who won't see them."

Learning to love Obamacare?

In other words, the Republicans argue, Obamacare is broken and can't be saved, so there's no choice but to repeal it and replace it with something else. They've been saying this all along, but the fact that premiums this year took a sharp upturn while many insurers withdrew their plans from states' exchanges is giving them some hefty ammunition. Perhaps paradoxically, just as Obamacare's repeal looks imminent, the law has reached its highest approval ratings since it was passed.

Trump dismissed this popularity upswing, saying that voters always like something best when it's about to go away. (He also made an offhand comment that "Nobody knew health care could be so complicated," that's been widely mocked in the press.)

Earlier today, Trump met briefly with top executives from UnitedHealth, Aetna, Cigna, Humana, Anthem, Blue Cross Blue Shield, and Kaiser Permanente, calling them "the biggest of the big." He went on to say, "Obamacare has been a disaster, and it's only getting worse."

Without detailing specifics, he told executives, "The new plan will be a great plan for the patients, for the people, and hopefully for the companies." Was that "hopefully" meant as a warning to insurers that they would have to cooperate with the new plan whether they liked it or not? Unclear.

What is clear, though, is that Republicans are very far from agreeing over how to handle Obamacare. In fact, Trump briefly floated the idea of not doing anything to it at all. "I actually told the Republicans that if we did nothing, just did nothing for a two-year period, let Obamacare totally implode, which it's doing right now anyway, that would be from a political standpoint the best thing we could do," he told the insurance executives.

Once Republicans take over the problem, "It becomes ours," he said. "But it's the right thing to do for the American people."

Published on: Feb 27, 2017
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