In an op-ed today, Rand Paul came out against the Republican idea of repealing the ACA and delaying any replacement.
Of course, being the libertarian that he is, Paul's idea for replacement is health savings accounts and the like -- what he calls "freedom -- which won't do anything to help folks with pre-existing conditions, but he's still right about the dangers of repealing the ACA without a replacement.
If Congress fails to vote on a replacement at the same time as repeal, the repealers risk assuming the blame for the continued unraveling of Obamacare. For mark my words, Obamacare will continue to unravel and wreak havoc for years to come.
My fear is that if you leave part of Obamacare in place (the dictate that insurance companies must sell insurance to individuals with pre-existing conditions) then you will see an acceleration of adverse selection and ultimately mass bankruptcy of the healthcare insurance industry.
Don’t misunderstand me. We should repeal Obamacare, but partial repeal will only accelerate the current chaos and may eventually lead to calls for a taxpayer bailout of insurance companies.
Let me be more concise. Partial repeal will invite a Medicare for All solution, because people are not going to tolerate being tossed off their health insurance for pre-existing conditions again, and without the full risk pool, including healthy people, it will cause hell for everyone who is not on Medicare or Medicaid.
I don't expect Rand Paul to have a lot of leverage on this. I do expect them to use some form of budget reconciliation to repeal parts of the ACA, while leaving others. It will break health policy in this country, which means we'd better start working on winning the House and the Senate in 2018 to stop the train wreck before it's too late.