Obamacare repeal fever: Obvious fixes, or a disastrous mess? Mastio & Lawrence

David: With the Republican alternative to Obamacare dead, Republican Senate Majority Leader Mitch McConnell, as much a representative of the GOP establishment class as you will find in Washington, and President Trump, leader of the populist rebellion, agreed that what Republicans needed to do is repeal the Affordable Care Act now and come up with some kind of alternative later.

That idea lasted a few hours before three moderate GOP senators killed it. Some Republicans see redemption in failure. Conservatives who have long fought Obamacare will be able to say they stood by their principles and fought. Swing state senators won’t have to defend their votes to kill Obamacare. Everybody wins!

But Republican voters are not going to look at it that way. The anger among those who have been disappointed by party leaders who make big conservative promises in election years and then fail to deliver is the animating force in GOP politics. It is the reason why Republican voters failed to back both GOP moderates such as Jeb Bush and conservative ideological warriors such as Sen. Ted Cruz last year. If you think the 2016 fallout was unpredictable, wait until you see who starts winning 2018 Republican primaries.

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The hopes to turn failure into some kind of political shield for Republicans also misunderstand the political nature of Donald Trump. He is not and never will be a conservative Republican. Men in their 70s who spent their lives more in line with Democrats don’t suddenly become ideological conservatives. Trump latched onto the Republican Party and has followed a conservative political strategy because that was the easiest avenue for him to bring his brand into politics.

But if the core of Trump’s political brand isn’t conservatism, what is it? The brand is built entirely on winning by rejecting business as usual. Six months into Trump’s presidency, he’s not winning. And Washington gridlock is the very definition of Washington business as usual.

Jill: I’m not sure this is how you go about maximizing political cover. In 1998, Republicans were so obsessed with President Clinton’s misbehavior that they might as well have been renamed the Impeachment Party. Two decades later, they are destined to be known as the party that tried really hard to take away your health insurance. Who is that going to help? House Republicans who voted for a cruel bill might be spared hard-core conservative primary opponents, but they’ll be playing very difficult defense in their general elections. The dragged-out Senate mess mainly functioned to keep alive the (true) fact that Republicans planned to throw millions off insurance in order to give tax cuts to the rich.

Leave it to Trump, of course, to set insurmountable bars for irresponsibility, inaccuracy, callousness, fantasy and hypocrisy, all in one press availability at the White House: 

• Obamacare is “a total disaster” — totally false.
• “Let Obamacare fail” — sure, stand by and watch as insurance markets, people’s nerves, their finances and in some cases maybe even their health go into the fabled “death spiral.”
• “I’m not going to own it. I can tell you the Republicans are not going to own it” — wanna bet? Good luck with that given the GOP controls the White House and Congress.
• We’re going to have “lower premiums, much lower costs and much better protection” — on what planet is that possible? Only Planet Trump.

So much for facts, figures and the buck stopping with a president. Only on Planet Trump, located in his head, would a president blame Democrats for his failure after tweeting in 2012: “Obama's complaints about Republicans stopping his agenda are BS since he had full control for two years. He can never take responsibility.”

It is very important to remember the bottom line here, and that is people and their lives — their quality of life, their finances, their productivity, the workforce and our overall economy. Why would we want to stop progress on all that in its tracks?

At the moment, that’s not going to happen thanks to three Republican women, Sens. Susan Collins of Maine, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska, who are against repeal without replace. All three were cut out of the all-male, all-white working group that came up with these genius proposals. As Abigail Adams would have said, “Remember the ladies.” Or else.

David: I won’t pretend to defend the Republicans’ cockamamie replacements for the dishonestly named Affordable Care Act. I could never follow the details because half the time, they were secret, and the rest of the time, they were flitting from plan to plan. You can’t build public support for your approach to health care if you don’t stick to it long enough for your most sympathetic possible audience to figure out what you are talking about.

The idea that Obamacare created some kind of health care utopia is a little hard to swallow. Before Trump set foot in office and while insurance company executives still thought Hillary Clinton would be elected president, the program was already coming apart at the seams.

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Insurers were withdrawing from providing insurance all over the country. Last August, the Kaiser Family Foundation was predicting that in 2017, there would be two or fewer insurers in 60% of U.S. counties, and one or even zero in 30%. That isn’t because of anything the Trump administration did. Competition was already collapsing.

And the collapse of competition was already hitting voters' wallets. Last October, ACASignups.net was reporting that average Obamacare premiums were going up by 25% for 2017. In eight states, they were going up by at least 30%. And those rate increases were what was approved by state regulators, not what insurance companies actually thought they needed.

That kind of inflation is simply unsustainable, and it is exactly what President Obama promised he would stop. “We agree on reforms that will finally reduce the costs of health care," Obama said in 2009. "Families will save on their premiums; businesses that will see their costs rise if we do nothing will save money now and in the future.”

And all that leaves aside the question of huge deductibles that left Americans buying insurance on the exchanges shelling out thousands to pay for coverage that didn’t really kick in until they spent thousands more on uncovered medical bills.

The fact is that when the non-partisan Congressional Budget Office looked at Republican plans for replacing Obamacare, the No. 1 reason that privately insured folks would “lose” coverage is because the Republican plan would no longer penalize people for not buying insurance. It doesn’t sound to me like the beneficiaries of Obamacare are fans of the plan if we have to force them to buy in.

The Republicans may have blown the politics of health care, but Democrats left us with a disastrously unstable system without any obvious fix.

Jill: There is a lot left out of these arguments, starting with sabotage of the ACA by many Republican governors and the entire congressional GOP. There could have been more competition and more cost control and more subsidies had Republicans tried to make the law work instead of trying in many cases to make sure it failed. Even so, the Kaiser Family Foundation now reports that the insurance market is stabilizing, that companies are becoming profitable, and that there is “no sign of a market collapse.” This is despite all the chaotic signals coming from Trump and Washington.

A large-scale study of Ohio’s Medicaid expansion to more than 700,000 people just above the poverty line found that the coverage had improved their health and financial situations. In fact, the bankruptcy rate has plummeted since the ACA took effect, a development attributed largely to a drop in medical bankruptcies.

As for what’s driving the drop in insured projected by the CBO, that number would be 15 million in 2018, and most indeed would be people who didn’t buy insurance because the requirement to buy it was gone. But in 2026, when 22 million fewer people would be insured, Medicaid cutbacks would account for 15 million of them.

I absolutely believe there are obvious fixes to many of these problems, and they invariably involve money: how much you spend and how you decide to spend it. Do you want to give rich people tax cuts, or do you want to provide larger subsidies and extend them to more people up the income scale? Cut taxes for rich people, or continue with the law’s “cost sharing reduction” payments that help insurance companies keep premiums affordable for lower-income people? Let experts come up with ways to keep costs down? Require transparency in pricing?

There are answers, even some that both parties could love or at least like. But first, apparently. Republicans need to get repeal fever out of their system and reopen their minds to working with Democrats. The parties are not enemies. On an issue like this, they sorely need to be partners.

David Mastio, a libertarian conservative, is the deputy editor of USA TODAY's Editorial Page. Jill Lawrence, a center-left liberal, is the commentary editor of USA TODAY. Follow them on Twitter @DavidMastio and @JillDLawrence.

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