A Republican proposal meant to tweak the Affordable Care Act could kick a million people off employer health coverage. This is the party's long-predicted political predicament in action: Obstructing Obamacare at this point almost certainly means reducing access to health insurance.
The analysis of the Republican plan came from the Congressional Budget Office, the same non-partisan group that earlier this month figured that Obamacare would reduce the number of hours worked by Americans 2 percent by 2024 (kicking off a massive debate). The CBO looked at the not-at-all-melodramatically-named Save American Workers Act offered by Indiana Rep. Todd Young, which would establish that a full-time employee is one who works 40 hours a week, not 30 as stipulated in the ACA. That change, which Young hoped would keep employers from keeping employees' hours at 29 to avoid triggering the need for insurance, would not be consequence free.
Young's bill, according to the CBO, would reduce the number of people receiving insurance from employers by 1 million, half of whom would get insurance from Medicaid or an Obamacare exchange and half of whom would be uninsured. It would also decrease income from penalties assessed to employers.
This is just one tweak, but it reveals the problem. Four million people have signed up for insurance on the Obamacare exchanges, and millions more have coverage under the expansion of Medicaid. Any substantial tweak to how the system works will upend some group — just as Obamacare itself created challenges for people who had existing, non-Obamacare-compliant plans. The difference is that this time the Republicans would also be on the hook for the repercussions, if they got any change passed and signed into law.
Not making it any easier politically is that some fringe Republicans embrace the idea of limiting access to health care. Georgia Gov. Nathan Deal has energetically fought the Obamacare rollout and, specifically, the optional expansion of Medicaid that some states embraced to expand coverage for poorer residents. On Monday, he suggested another tweak to federal healthcare policy: revoke a 1986 law that guaranteed emergency room access regardless of ability to pay. The Newnan Times-Herald reports that Deal told an audience he supported rescinding the law, because it "came as a result of bad facts." He continued: "I think we should be able in this passage of time to figure out ways to deal with those situations but not have the excessive costs associated with unnecessary visits to the emergency room." In emergency situations, passage of time is generally not an asset.
There's an important footnote at the bottom of the article about why Georgia emergency rooms are facing budget problems: "many hospitals in rural Georgia are caught in the financial pinch caused by the governor’s refusal to expand Medicaid rolls, and the Affordable Care Act’s reduction of federal cash for indigent care." In other words: If Deal accepted the Medicaid expansion, those hospitals would be reimbursed by more low-income patients. But instead of accepting that aspect of a law he hates, Deal thinks the solution is to block low income patients.
That's an extreme. But on the macro level, the challenge is the same. The disruptions to the healthcare system under Obamacare aren't over yet, but they're baked in. A new system that would effectively rescind healthcare access for Americans, particularly those millions that never had it, is a tough political prospect. Which is why Obamacare opponents have largely been content to call for reform in the abstract, especially with November elections looming.
Update, 2:30 p.m.: A new poll from the Kaiser Family Foundation finds that a majority of Americans want to keep Obamacare in place. The Washington Post's Greg Sargent speculates that it may be the case that "the American mainstream doesn’t believe there is any real GOP alternative to Obamacare and understands that despite its flaws, the Affordable Care Act is the only set of solutions we’re going to get."