“Failure is a familiar outcome in U.S. health policy,” writes Dr. Jonathan Oberlander, in the opening of a New England Journal of Medicine “Perspective” article, published online April 5.
Dr. Oberlander, professor of health policy and management at UNC’s Gillings School of Global Public Health and professor and chair of social medicine at UNC’s medical school, is nationally renowned for his analyses of the United States’ Affordable Care Act (ACA), often referred to as “Obamacare.”
[Photo: Dr. Jonathan Oberlander (photo by Max Englund)]
In the April 5 article, Dr. Oberlander calls the Trump administration’s efforts to repeal and replace the ACA an “epic” failure, even when cast against the failed national health insurance coverage programs proposed by presidents Nixon, Carter and Clinton. He points to the partisan and ideological polarization among congressional representatives – including within the Republican party – as the primary cause of the failure to repeal and replace the ACA.
“Hyperpartisanship has dented the ACA’s political fortunes, complicated its implementation and created an increasingly dysfunctional and conflict-ridden federal government,” he writes.
Speaker Paul Ryan and the Trump administration believed they could convince all House conservatives to vote for a bill they did not fully support so as to take advantage of the opportunity to repeal a much-hated health care program and support a president from their party. That – and the decision to insist upon a quick repeal without careful planning – was miscalculation that “generated a perfect storm of opposition” and resulted in the effort’s failure.
“What will Republicans do next?” Dr. Oberlander asks. They either can cooperate with Democrats to reform the bill, which is unlikely, or resurrect efforts to repeal and replace it, which already may be underway. If the bill is not improved or repealed, the administration could use a number of options to undermine the ACA, including weakening enforcement related to consumers’ noncompliance and no longer requiring insurance companies to provide discounted coverage to lower-income Americans.
“Nobody knew that health care could be so complicated,” the current president remarked during the congressional discussions. It is even more complicated now that 20 million Americans have begun to think of health care not as a luxury, but as a right – one they do not want to see eroded.