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A slow, painful death for Obamacare

With a new Congress in Washington, an old fight resumes — but with the only certainty that there will be a great deal of obfuscation involved. Congressional Republicans are once again determined to "repeal and replace" the Affordable Care Act, but exactly what that means for health care coverage isn't entirely clear.

What does seem likely is that the GOP will push through a resolution setting some sort of timetable for repealing Obamacare that might extend several years but could be signed into law in a matter of weeks and probably no later than this spring. It is unlikely to amount to a full repeal given that President-elect Donald Trump has already signaled his own support for key Obamacare provisions such as prohibiting insurance companies from denying coverage based on pre-existing medical conditions or allowing children to remain on their parents' health plans up until age 26.

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And what will the "replacement" of the ACA look like? That's an even bigger mystery given the lack of consensus within the majority party. But leadership has indicated that it will involve fewer mandates and that they will use budget authority to get it done — meaning it won't require a 60-vote filibuster-proof majority in the Senate.

This may produce a happy moment for the partisan crowd that has been hankering to kill the Affordable Care Act since it was signed into law in 2010, but it's also likely to immediately roil the health insurance market, making health insurance all the more costly to consumers. Why would any insurance company be interested in entering the health care exchange marketplace given its increasingly uncertain future? And it's this lack of competition within the exchanges that's proven to be one of the ACA's biggest problems.

No wonder many Republicans are anxious to repeal the ACA symbolically but delay any meaningful changes to the law. Here's but one example of the problem facing conservatives — coal-mining counties that supported Mr. Trump in overwhelming numbers could now face devastating, life-shortening consequences with Obamacare's repeal, specifically with an ACA provision that extended benefits for former miners suffering from black lung disease.

Perhaps a rewrite of Obamacare will preserve these benefits, but there's certainly no guarantee. And many millions of Americans will be living under the proverbial Sword of Damocles for months or years while waiting to hear if congressional Republicans will extend supplemental federal spending — whether through the individual insurance marketplace or the Medicaid expansion — so that they can afford insurance coverage.

Such uncertainty should not be taken lightly. It's the difference between knowing that one's financial future is secure and worrying that a single major medical event, a heart attack or cancer diagnosis, for example, could lead to bankruptcy and financial ruin. And given that Obamacare has caused the rate of U.S. uninsured to fall to historically low levels (8.6 percent for all Americans), some 20 million or more may be affected by the repeal.

So what are Republicans really so anxious to accomplish? To demonstrate that their promise to repeal Obamacare was serious? That might be a political accomplishment, but it isn't achieving much policy-wise. The provision the Obamacare critics seem to hate the most — the individual mandate — was simply the means (putting more healthy people in the risk pool) to compensate insurance companies for costly ACA reforms that people actually like.

This repeal and delay trickery is only bound to make matters worse. Insurance companies will withdraw from the individual market, insurance exchanges will collapse, prices will increase, fewer people will be covered and a lot of people will suffer — including health care providers, which in turn hurts the overall economy. What kind of political victory is that?

Perhaps when the dust settles, the best that can be said is that the health insurance market will return to the inadequate, increasingly-burdensome-to-employers and dysfunctional system it was prior to Obamacare. People who are rich or are lucky enough to work for large, deep-pocketed employers who provide generous health benefits may be perfectly satisfied with that. The rest of us won't be, and there will surely be a political price for members of Congress who deny decent and affordable health care to millions — as soon as those folks figure out they've been hoodwinked.

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