For Obamacare, for all of the talk of repeal and replace, I think it unlikely to happen because there aren't many other good options to replace it with. Most people like the ACA generally, except for the mandate, but there isn't a viable alternative to the ACA without it, since it is the feature that makes the whole system feasible.
I think this is correct. Everyone says they want to keep the protections for pre-existing conditions, but they really don't work without the mandate or you only have sick people buying insurance. I don't see the insurance lobby letting the pre-existing conditions clauses stand and the mandate go away. And once you've got the mandate, you've got to have a way for poor people to get it, which leads to subsidies and/or medicaid expansion. Repeal is easy, replace not so much.
My guess is that decision-making about it will be punted down the line for several years. Subsidies will continue to decrease, premiums will continue to increase, and the overall marketplace will wither.
That may be how they ultimately phase it out. I won't be surprised to see some tweaks like coverage minimums and cross state line selling go through pretty quickly and victory declared. And as others have said cross state line insurance selling doesn't do much. The hard part is negotiating deals with Drs & hospitals to be competitive. If you're not in that state, there is probably a reason.
I definitely think it will be punted for a while, amidst minor tweaks that are hailed as huge overhauls.
However, I personally think that the GOP feels NO pressing need to really replace Obamacare with anything. Generally speaking, most Dems consider access to healthcare to be a right of all citizens, and also believe that it should not be financially out of reach for someone of low income, nor should people go bankrupt due to health issues. If these things occur, the gov't should be trying to rectify that.
In contrast most members of the GOP I suspect DO NOT believe access to healthcare is a right, nor do they think government should necessarily have any role in helping people get access. I'm pretty most them would be perfectly fine with reverting to the old system and dumping everybody straight back to being uninsured.
This expectation that the GOP will provide an alternative to Obamacare makes sense if the majority of the PEOPLE WHO VOTE had truly agreed that ALL people should have access to health insurance (and at least semi-affordable health care). But the voters seem to be pretty much split.
Now consider on top of the divergence in philosophy, that as a purely practical matter, the GOP wants individuals to bear more of the cost of healthcare, and the gov't to bear less. Ryan's Medicare voucher idea is set up specifically so that it DOES NOT keep pace with projected healthcare costs over time, with the goal of gradually shifting the cost of health insurance and/or health care in insurance to the individual. Cleverly, he 'buys' the vote of those already on Medicare (who definitely DO vote) by grandfathering them in. But his idea is that eventually we would all each pay most of the cost of our health care coverage. That's not a bug, it's a feature of the plan because of the philosophy underlying it.
When it comes right down to it, I really don't think most GOP members care that much that people die from lack of affordable insurance. They feel those people should find a way to pay for it themselves. They also feel that if the government didn't subsidize health care, costs would go way down, and more people could pay for it. But even if costs don't drop, and more and more people are forced to go without, their underlying philosophy doesn't push them to do anything about it.
Now, I like to think that the bad press and the voter pressure that would arise if millions of people are 'dumped' would convince the GOP to come up with a workable alternative, but then I remember that 1) Obamacare WAS their alternative, back in the 1990s; and 2) most of those affected would be very poor people, and politicians just don't care that much what happens to the poor, who don't vote in large numbers as much anyway, particularly in the midterms, and who can't compete with the clout of the insurance companies or their own hardcore lock-step constituents who always want to cut taxes and government spending and who always vote.
So....I think we could easily just go back to the old system, where you could only get healthcare if you can find work that covers you with a benefit package. And let COBRA etc. cover the rest. Or not.
