Snatching Health Care Away From Millions<\/a><\/h1>\n![\"\"](\"https:\/\/i0.wp.com\/napervilledemocrats.org\/ntdo\/wp-content\/uploads\/2017\/01\/krugman-health-care-from-millions-300x213.jpg?resize=300%2C213\")
<\/a>Karen Bleier\/Agence France-Presse \u2014 Getty Images<\/p><\/div>\n
<\/p>\n
If James Comey, the F.B.I. director, hadn\u2019t tipped the scales in the campaign\u2019s final days with that grotesquely misleading letter, right now an incoming Clinton administration would be celebrating some very good news. Because health reform, President Obama<\/a>\u2019s signature achievement, is stabilizing after a bumpy year.<\/p>\n <\/p>\n
This means that the huge gains achieved so far \u2014 tens of millions of newly insured Americans<\/a> and dramatic reductions in the number of people skipping treatment or facing financial hardship<\/a> because of cost \u2014 look as if they\u2019re here to stay.<\/p>\n <\/p>\n
Or they would be here to stay if the man who squeaked into power thanks to Mr. Comey and Vladimir Putin wasn\u2019t determined to betray his supporters, and snatch away the health care they need.<\/p>\n
<\/p>\n
To appreciate the good news about Obamacare you need to understand where the earlier bad news came from. Premiums on the exchanges, the insurance marketplaces created by the Affordable Care Act, did indeed rise sharply this year, because insurers were losing money. But this wasn\u2019t because of a surge in overall medical costs<\/a>, which have risen much more slowly since the act was passed than they did before. It reflected, instead, the mix of people signing up \u2014 fewer healthy, low-cost people than expected, more people with chronic health issues.<\/p>\n <\/p>\n
The question was whether this was a one-time adjustment or the start of a \u201cdeath spiral,\u201d in which higher premiums would drive healthy Americans out of the market, further worsening the mix, leading to even higher premiums, and so on.<\/p>\n
<\/p>\n
And the answer is that it looks like a one-shot affair. Despite higher premiums, enrollments in the exchanges are running ahead<\/a> of their levels a year ago; no death spiral here. Meanwhile, analysts are reporting substantial financial improvement for insurers: The premium hikes are doing the job, ending their losses<\/a>.
\nIn other words, Obamacare hit a bump in the road, but appears to be back on track.<\/p>\n <\/p>\n
But will it be killed anyway?<\/p>\n
<\/p>\n
In a way, Democrats should hope that Republicans follow through on their promises to repeal health reform. After all, they don\u2019t have a replacement, and never will. They\u2019ve spent seven years promising something very different from yet better than Obamacare, but keep failing to deliver, because they can\u2019t; the logic of broad coverage, especially for those with pre-existing conditions, requires either an Obamacare-like system or single-payer, which Republicans like even less. That won\u2019t change.<\/p>\n
<\/p>\n
As a result, repeal would have devastating effects, with people who voted Trump among the biggest losers. Independent estimates suggest that Republican plans would cause 30 million Americans to lose coverage<\/a>, with about half the losers coming from the Trump-supporting white working class. At least some of those Trump supporters would probably conclude that they were the victims of a political scam \u2014 which they were.<\/p>\n <\/p>\n
Republican congressional leaders like Paul Ryan<\/a> nonetheless seem eager to push ahead with repeal. In fact, they seem to be in a great rush<\/a>, probably because they\u2019re afraid that if they don\u2019t unravel health reform in the very first weeks of the Trump era, rank-and-file members of Congress will start hearing from constituents who really, really don\u2019t want to lose their insurance.<\/p>\n <\/p>\n
Why do the Republicans hate health reform? Some of the answer is that Obamacare was paid for in part with taxes on the wealthy, who will reap a huge windfall<\/a> if it\u2019s repealed, even as many middle-income families face tax hikes.<\/p>\n <\/p>\n
More broadly, Obamacare must die precisely because it\u2019s working, showing that government action really can improve people\u2019s lives \u2014 a truth they don\u2019t want anyone to know.<\/p>\n
<\/p>\n
How will Republicans try to contain the political fallout if they go ahead with repeal, and tens of millions lose access to health care? No doubt they\u2019ll try to distract the public \u2014 and the all-too-compliant news media \u2014 with shiny objects of various kinds.<\/p>\n
<\/p>\n
But surely a central aspect of their damage control will be an attempt to push a false narrative about Obamacare\u2019s past. Health reform, they\u2019ll claim, was always a failure, and it was already collapsing on the eve of the G.O.P.<\/a> takeover. When the number of uninsured Americans skyrockets on their watch, they\u2019ll claim that it\u2019s not their fault \u2014 like everything, it\u2019s the fault of liberal elites.<\/p>\n <\/p>\n
So let\u2019s refute that narrative in advance. Obamacare has, in fact, been a big success \u2014 imperfect, yes, but it has greatly improved (and saved) many lives. And all indications are that this success is sustainable, that the teething problems of health reform weren\u2019t fatal and were well on their way to being solved at the end of 2016.<\/p>\n
<\/p>\n
If, as seems all too likely, a health care debacle is imminent, blame must be placed where it belongs: on Donald Trump<\/a> and the people who put him over the top.<\/p>\n<\/blockquote>\n
<\/a>Karen Bleier\/Agence France-Presse \u2014 Getty Images<\/p><\/div>\n
<\/p>\n
If James Comey, the F.B.I. director, hadn\u2019t tipped the scales in the campaign\u2019s final days with that grotesquely misleading letter, right now an incoming Clinton administration would be celebrating some very good news. Because health reform, President Obama<\/a>\u2019s signature achievement, is stabilizing after a bumpy year.<\/p>\n <\/p>\n This means that the huge gains achieved so far \u2014 tens of millions of newly insured Americans<\/a> and dramatic reductions in the number of people skipping treatment or facing financial hardship<\/a> because of cost \u2014 look as if they\u2019re here to stay.<\/p>\n <\/p>\n Or they would be here to stay if the man who squeaked into power thanks to Mr. Comey and Vladimir Putin wasn\u2019t determined to betray his supporters, and snatch away the health care they need.<\/p>\n <\/p>\n To appreciate the good news about Obamacare you need to understand where the earlier bad news came from. Premiums on the exchanges, the insurance marketplaces created by the Affordable Care Act, did indeed rise sharply this year, because insurers were losing money. But this wasn\u2019t because of a surge in overall medical costs<\/a>, which have risen much more slowly since the act was passed than they did before. It reflected, instead, the mix of people signing up \u2014 fewer healthy, low-cost people than expected, more people with chronic health issues.<\/p>\n <\/p>\n The question was whether this was a one-time adjustment or the start of a \u201cdeath spiral,\u201d in which higher premiums would drive healthy Americans out of the market, further worsening the mix, leading to even higher premiums, and so on.<\/p>\n <\/p>\n And the answer is that it looks like a one-shot affair. Despite higher premiums, enrollments in the exchanges are running ahead<\/a> of their levels a year ago; no death spiral here. Meanwhile, analysts are reporting substantial financial improvement for insurers: The premium hikes are doing the job, ending their losses<\/a>. <\/p>\n But will it be killed anyway?<\/p>\n <\/p>\n In a way, Democrats should hope that Republicans follow through on their promises to repeal health reform. After all, they don\u2019t have a replacement, and never will. They\u2019ve spent seven years promising something very different from yet better than Obamacare, but keep failing to deliver, because they can\u2019t; the logic of broad coverage, especially for those with pre-existing conditions, requires either an Obamacare-like system or single-payer, which Republicans like even less. That won\u2019t change.<\/p>\n <\/p>\n As a result, repeal would have devastating effects, with people who voted Trump among the biggest losers. Independent estimates suggest that Republican plans would cause 30 million Americans to lose coverage<\/a>, with about half the losers coming from the Trump-supporting white working class. At least some of those Trump supporters would probably conclude that they were the victims of a political scam \u2014 which they were.<\/p>\n <\/p>\n Republican congressional leaders like Paul Ryan<\/a> nonetheless seem eager to push ahead with repeal. In fact, they seem to be in a great rush<\/a>, probably because they\u2019re afraid that if they don\u2019t unravel health reform in the very first weeks of the Trump era, rank-and-file members of Congress will start hearing from constituents who really, really don\u2019t want to lose their insurance.<\/p>\n <\/p>\n Why do the Republicans hate health reform? Some of the answer is that Obamacare was paid for in part with taxes on the wealthy, who will reap a huge windfall<\/a> if it\u2019s repealed, even as many middle-income families face tax hikes.<\/p>\n <\/p>\n More broadly, Obamacare must die precisely because it\u2019s working, showing that government action really can improve people\u2019s lives \u2014 a truth they don\u2019t want anyone to know.<\/p>\n <\/p>\n How will Republicans try to contain the political fallout if they go ahead with repeal, and tens of millions lose access to health care? No doubt they\u2019ll try to distract the public \u2014 and the all-too-compliant news media \u2014 with shiny objects of various kinds.<\/p>\n <\/p>\n But surely a central aspect of their damage control will be an attempt to push a false narrative about Obamacare\u2019s past. Health reform, they\u2019ll claim, was always a failure, and it was already collapsing on the eve of the G.O.P.<\/a> takeover. When the number of uninsured Americans skyrockets on their watch, they\u2019ll claim that it\u2019s not their fault \u2014 like everything, it\u2019s the fault of liberal elites.<\/p>\n <\/p>\n So let\u2019s refute that narrative in advance. Obamacare has, in fact, been a big success \u2014 imperfect, yes, but it has greatly improved (and saved) many lives. And all indications are that this success is sustainable, that the teething problems of health reform weren\u2019t fatal and were well on their way to being solved at the end of 2016.<\/p>\n <\/p>\n If, as seems all too likely, a health care debacle is imminent, blame must be placed where it belongs: on Donald Trump<\/a> and the people who put him over the top.<\/p>\n<\/blockquote>\n
\nIn other words, Obamacare hit a bump in the road, but appears to be back on track.<\/p>\n