Obamacare repeal is coming — piece by piece and in the worst possible way

Obamacare repeal's hidden secrets: tax cuts for the rich, a new burden for seniors, Medicaid downsizing and more

Published December 12, 2016 12:58PM (EST)

  (Reuters/Scott Morgan/AP/J. Scott Applewhite/Photo montage by Salon)
(Reuters/Scott Morgan/AP/J. Scott Applewhite/Photo montage by Salon)

As wonderful as the Affordable Care Act has been for millions of previously uninsured Americans, I'm not breaking any news by observing that it's a tremendously complicated set of laws aimed at reforming an insanely complicated insurance industry. The wonky nature of the law is perhaps the biggest advantage the Republicans will have when it comes to repealing and replacing it next year.

Few A-list pundits and even fewer lawmakers can adequately talk about what's in Obamacare. (You might recall how the president-elect described part of the law as covering "kids who live with their parents," which actually isn't part of the law.)

Likewise, few pundits and lawmakers understand how treacherous it will be to destroy the ACA and voters themselves understand even less. This dynamic has created a huge loophole through which the GOP has relentlessly injected misinformation and outright lies. Again, the more complicated the law happens to be, the easier it is to confuse and mislead voters.

For example, House Speaker Paul Ryan and the congressional Republicans, not to mention 2012 presidential candidate Mitt Romney, continuously screeched about how the ACA had ruined Medicare. That's completely untrue. The ACA extended the solvency of Medicare by 11 years, while trimming billions in waste, fraud and abuse. The ACA also phases out the Medicare Part-D "doughnut hole" — the coverage gap whereby elderly Americans previously were forced to pay for meds out of pocket or go without. But the relationship between Medicare and Obamacare is complicated, so it's easy for Ryan and others to engage in demagoguery.

Here's a few more things you won't hear Republicans talking about anytime soon.

The ACA is much more than just the Patient Protection and Affordable Care Act. There's the ACA law, of course, but there's also another separate law that amended the ACA. Known as the Health Care and Education Reconciliation Act of 2010, this second ACA-related law contains all of the budget-related measures linked to Obamacare, including the individual mandate, the Medicaid expansion, the federal subsidies for lower-income Americans, the aforementioned closure of the "doughnut hole," a Medicare tax increase on Americans earning more than $250,000 and so on.

Things become more complicated when we discover that the Student Aid and Fiscal Responsibility Act was attached to the 2010 health care reconciliation act as a rider. This third piece of the ACA puzzle included major student-loan reforms, including the expansion of Pell grants as well as the implementation of President Barack Obama's plan for eliminating private banks from the federal student aid program, effectively reducing student loan debt while also cutting the deficit by billions.

That's certainly a mouthful. But all that stuff is part of the package collectively known as Obamacare, and the GOP is ready to kill it all. They'll start with the 2010 health care reconciliation act  because they have the votes. Every single reform you just read about in the previous paragraph (and more) will likely be repealed by the next Congress. To do so, the GOP needs only 51 votes in the Senate due to a rule that allows for a majority "reconciliation" vote on budget-related bills. The Senate Democrats can't filibuster a repeal of the 2010 health care reconciliation act and they lack the votes to block the reconciliation process unless a few Republicans flip sides and join them. 

In any case, the GOP needs only 51 votes in the Senate to repeal the mandate, the subsidies, the closing of the doughnut hole, the Medicaid expansion and all those tasty student loan reforms. Any "Never Hillary" millennials who voted for Jill Stein or stayed home because Clinton didn't adequately adopt Bernie Sanders' debt-free college plan should be especially alarmed by this news. So should elderly Americans, who'll have no choice but to endure a grand reopening of the doughnut hole, forcing them to go without medication or to pay out of pocket for a month or two each year. Again, this is the part of the bill that the GOP will be able to easily repeal. And they will.

On top of all that, a 51-vote repeal of the Health Care and Education Reconciliation Act of 2010 will also include a huge tax break for wealthy earners. When we say "huge," we mean it. Scrapping this act will result in a $346 billion tax cut over 10 years for families earning more than $250,000. That's great news for rich people, but horrible news for the rest of us. 

Making matters worse, repealing the 2010 health care reconciliation act — or doing away with it along with its sister-law, the ACA — could strip as many as 37 million Americans of their health care coverage. Let's do the numbers. There are about 12.5 million adults with coverage through the ACA, with another 18 million people covered under the Medicaid expansion, along with young people and kids who are covered under their parents' plans or via the Children's Health Insurance Program, which Obamacare expanded with greater benefits. Furthermore, if Republicans haphazardly repeal the law, it could destabilize the health insurance industry, forcing insurers to abandon the individual marketplace and retreating to strictly group plans.

We haven't even mentioned all the known knowns in a repeal process. We know that the Republicans don't have a viable replacement plan for Obamacare. We also know that Democrats will filibuster a repeal of the ACA law, which they have enough votes to do. But the structure of the law can't hold up for long if it's missing the financial elements contained in the reconciliation act. The upshot will be mayhem and, as time rolls on, a lot of uninsured sick or injured people whose health care will be stripped away from them, thanks to greedy and vindictive Trump supporters who have been brainwashed by a superficial horse-race news media and a lying GOP into thinking the ACA is a disaster.

Weirdly, a large majority of Americans love the individual parts of the ACA, but many cringe when they hear the portmanteau "Obamacare." Hence, the repeal is more about sticking it to Obama than anything else. Sadly, tens of millions of Americans will lose their health care simply because Trump voters yearned for Obama payback. It's difficult to describe how tragic that is. Rank ignorance could rewind the clock to a time when thousands of Americans died every month because they lacked health insurance.

By Bob Cesca

Bob Cesca is a regular contributor to Salon. He's also the host of "The Bob Cesca Show" podcast, and a weekly guest on both the "Stephanie Miller Show" and "Tell Me Everything with John Fugelsang." Follow him on Facebook and Twitter. Contribute through LaterPay to support Bob's Salon articles -- all money donated goes directly to the writer.