President-elect Donald Trump and other Republican leaders may be determined to repeal the Affordable Care Act immediately, but a few more sensible members of the party are now trying to slow down this runaway train. They recognize the danger in destroying a program that directly benefits 22 million Americans — and indirectly millions more by controlling costs — without a plan to replace it.
That perhaps obvious insight has yet to penetrate Mr. Trump’s reality distortion field. He said on Tuesday that Congress should vote to repeal the law as early as next week and replace it with new legislation “very shortly thereafter.” His statements once again demonstrated cluelessness or indifference to how laws are made, especially in a field as complicated as health care. Most experts think that it could well take years for lawmakers to replace a law that requires insurers to sell affordable policies to people with pre-existing medical conditions, provides subsidies to help people buy insurance and encourages doctors and hospitals to reduce unnecessary and expensive medical procedures.
The House speaker, Paul Ryan, claimed on Tuesday that Republicans would try to repeal and replace the law “concurrently.” He offered few details, but his statement suggests Congress won’t repeal the A.C.A. for several months at least. On Monday, five Republican senators — Bill Cassidy of Louisiana, Susan Collins of Maine, Bob Corker of Tennessee, Lisa Murkowski of Alaska and Rob Portman of Ohio — faced up to that reality. They proposed slowing down a budgetary process designed by congressional leaders to effectively kill the most important parts of Obamacare by defunding them.
Two Republican governors, John Kasich of Ohio and Rick Snyder of Michigan, have said that Congress ought to preserve parts of the law, like its expansion of Medicaid, which has improved care for the poor and reduced the heavy burden of charity care at hospitals. About 665,000 people in Ohio and 614,000 in Michigan gained coverage under Medicaid expansion as of December 2015, according to the Kaiser Family Foundation.
The fact is, Obamacare is working, and it is reaching more Americans. As of Dec. 24, about 11.5 million people had signed up for health insurance for 2017 on federal and state health exchanges, 300,000 more than a year earlier. And the law made it possible for 10.7 million people to sign up for Medicaid who did not previously qualify.
Voting for repeal without a decent alternative would be inhumane. It could also be politically disastrous. About 47 percent of Americans don’t want Congress to scrap the law and 28 percent say lawmakers should come up with a replacement first, according to Kaiser.
Repeal’s fiscal consequences also pose a significant problem for Republican deficit hawks like Senator Rand Paul of Kentucky. The budget resolution that is the vehicle for repeal would add more than $2 trillion to the federal debt in the next 10 years, according to the Office of Management and Budget. That’s partly because the law has reduced the deficit by bringing in more revenue than it spends.
If Mr. Trump, his aides and other party leaders have ideas for preserving health coverage, improving medical care and reducing costs, they ought to present them to the public before they start dismantling Obamacare. The truth is, they have nothing more to offer than campaign slogans.