A Legacy That Cannot be Repealed

In the midst of perhaps the wildest healthcare debate since Medicare was introduced in 1965, it can be easy to miss moments of significance amid the noise. But last week contained a moment too big to overlook, and it came in the form of a “compromise” introduced by Senator Ted Cruz of Texas. The so-called Cruz amendment was added to the Better Care Reconciliation Act (BCRA) put forth by the Republican Senate to replace the Affordable Care Act (i.e., Obamacare). The amendment would essentially create two markets for health insurance: one where plans had to comply with all the regulations put in place by Obamacare, and another where they did not. In other words, insurers could return to their old practices of offering skimpy plans with few covered benefits, underwriting premiums based on medical need, and denying coverage based on pre-existing conditions, as long as they offered at least one plan which met the ACA’s standards.

The amendment all but guarantees an exodus of healthy people from the ACA-compliant market to the non-compliant market, where they would find cheaper premiums for worse plans. This exodus would result in a much sicker and more expensive pool for ACA-compliant plans, and in order to break even, insurers would have to raise premiums substantially. While the Congressional Budget Office is yet to release an estimate on the amendment, and while tax credits could incentivize healthy people below a certain income to stay in the ACA market, Cruz’s proposal would place a serious financial burden on an estimated 1.5 million people with pre-existing conditions—a burden exacerbated by BCRA’s deep cuts to safety net programs like Medicaid. In short, this proposal was destined to get a good deal of criticism.

But even the staunchest liberal could not have predicted the barrage of condemnation which the Cruz amendment received in the following days. Democrats, Republicans, policy wonks, journalists, doctors, patients and most shockingly of all, insurers, who called the amendment “unworkable in any form,” all came out in opposition to the proposed change. In a field so accustomed to division and debate, the healthcare world—with the exception of an extremely flawed HHS report—unanimously denounced this amendment.

This, in and of itself, does not seem too significant. In fact it seems predictable: a proposal which places an extreme burden on the sickest and most vulnerable in our society ought to be denounced. But six years ago the notion of a largely unregulated insurance market which punished the sick wasn’t an unacceptable proposition; it was an accepted reality. As Secretary Price said in a widely derided statement, the Cruz amendment essentially calls for insurers to “dust off how they did business before Obamacare.” And its unanimous rejection reveals Obamacare’s greatest accomplishment: it has fundamentally changed how America views healthcare.  

It’s the same reason Democratic protesters have filled congressional offices demanding no cuts to Medicaid, despite the fact that Bill Clinton proposed the same type of per-capita caps featured in the BCRA a mere two decades ago. For all the deserved criticism the ACA has received, for all its failures and missteps, the law has transformed America’s sentiments about the most intimate of policies: healthcare. Whatever happens in congressional chambers in the coming weeks, one thing seems clear: America does not want to go back to the way healthcare was done before Obamacare. And that’s a legacy that cannot be repealed.

Jacob Toner Gosselin is Managing Editor of The Gate. Opinions expressed in this article do not necessarily reflect the views of the publication. The image featured in this article is licensed under Creative Commons. The original image can be found here.