Reversal of fortune: Obamacare rate hikes pose headache for Republicans
Obamacare premiums are once again poised to spike by double digits in 2019, causing heartburn for politicians as voters will head to the polls within days of learning about the looming hit to their pocketbooks.
But unlike recent campaign cycles, when Republicans capitalized on Obamacare sticker shock to help propel them to control of Congress and the White House, they’re now likely to be the ones feeling the wrath of voters.
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That’s because Republicans are now in total control of the federal government and therefore on the hook for the health care system’s chronic shortcomings. Polling data has consistently suggested that more voters will blame Republicans for future problems with Obamacare. In addition, the GOP’s repeated failures to repeal Obamacare after eight years of campaign promises will make it difficult to galvanize the base on health care.
Democrats and their allies have been hammering President Donald Trump and congressional Republicans for “sabotaging” the health care markets and driving up premiums. Protect Our Care has been running digital ads in 13 states featuring news coverage of big rate hikes and concluding with a sound bite from Trump: “Let Obamacare implode.”
They hope that message will stick with voters come November.
“The political implications go only as far as people understand that they are a direct consequence of the administration’s actions,” said Rep. Raul Ruiz (D-Calif.), a medical doctor who sits on a key committee that oversees health care. “If they realize that, then they will be very, very upset with them.”
In particular, Democrats blame Republicans for eliminating the mandate penalty for failing to obtain health insurance, which was designed to be a cudgel to compel people who might otherwise go uninsured to buy coverage. They also point to the Trump administration’s efforts to make it easier to buy skinnier, cheaper plans that don’t meet the Affordable Care Act’s coverage requirements and patient protections as an exacerbating factor.
“Once they fractured the mandate, that changed the insurance pool,” said Rep. Richard Neal (D-Mass.), ranking member on the Ways and Means Committee. “Insurance is based upon shared risk, meaning fewer people contributing, the premiums escalate.”
Republicans scoff at the notion that they’re to blame for Obamacare’s failings. They point out that big rate hikes were a chronic condition of the exchange markets long before they took full control of the government.
“The Affordable Care Act has been a total failure,” said Rep. Buddy Carter (R-Ga.), a pharmacist who serves on one of the key House committees dealing with health care. “It’s been a train wreck since Day One. What we’re trying to do is to fix it.”
Republicans further argue that Democrats sabotaged a bipartisan effort to pass legislation designed to stabilize the markets and reduce rate hikes. They contend that Democratic concerns over abortion language that ultimately derailed the deal were a smokescreen.
“They are the reason why we didn’t pass the legislation that would have solved the issue,” said Sen. Bill Cassidy (R-La.), who has been closely involved in efforts to come up with a Republican plan to replace the ACA. “I can only guess that it’s politics.”
Democrats counter that the GOP added the abortion restrictions knowing that would be the deal-breaker.
Insurance experts generally agree that the rate hikes will be more severe because of actions taken by the Republican-led Congress and the Trump administration.
“If it hadn’t been for the individual mandate being repealed, and the threat of short-term and other loosely regulated plans proliferating, I think we would have seen single-digit premiums increases,” said Cynthia Cox, an insurance expert at the Kaiser Family Foundation. “Insurers are performing much better on the exchange markets than they had in the early years.”
However, that strong financial performance of the markets is also complicating Democratic talking points about sabotage. In many states, competition is increasing as insurers see opportunities to move into markets with little competition. Most notably, Oscar Health — the tech-friendly startup that’s lost hundreds of millions in the Obamacare markets — is entering or expanding its footprint in six states.