President Trump and his allies in Congress failed in their effort to "repeal and replace" Affordable Care Act (ACA), so they have settled upon a "wreck and rejoice" strategy instead.
In a tweet celebrating Congressional passage of the tax bill, the President declared "Obamacare has been repealed."
That's not true, of course. While the tax law deletes the ACA's tax penalty for those who are not enrolled in a qualified health insurance plan, the ACA is still alive.
If the repeal of the mandate was supposed to be a dagger in the heart of Obamacare, it missed its mark. The heart of Obamacare still beats. The insurance exchanges remain in place, as does the expansion of Medicaid coverage.
The Congressional Budget Office estimates, however, that there will be 4 million fewer people will have insurance coverage by 2019, and by 2027, there will be 13 million fewer enrollees. As a result, insurance premiums for enrollees will be 10 percent higher by 2027 than they would have been otherwise.
Whether or not the repeal of the mandate wrecks the ACA, it is hardly cause for rejoicing. Not long ago the President was bragging about creating a "beautiful" replacement for Obamacare that would provide broader and better coverage.
That thought, however "beautiful" it was in its conception, has now been abandoned in favor of maiming the ACA by any means possible.
Repeal of the ACA's enrollment mandate will be especially harmful with respect to contraceptive coverage. The CBO's report does not give us a breakdown of the 13 million people who, by 2027, will not be enrolled in an insurance plan, but many of them will be younger people who elect to drop their coverage once the tax penalty for non-enrollment is lifted.
And many of them will be women who might otherwise benefit from the ACA's "contraceptive mandate."
Subject to religious exemptions, the mandate requires insurers to cover contraceptive services without requiring a co-pay. Younger women, in particular, have benefited from the expanded coverage. The cost-savings for women electing to be sterilized, or to have an IUD or an implant, can be over $1,000.
The Trump administration has already issued new regulations aimed at weakening the contraceptive mandate. Under the new rules, insurers or employers with any religious or moral objections can now drop their coverage of contraception. They don't even have to inform the government.
The larger, unanswered question for the ACA is, what comes next? The Senate Majority Leader, Mitch McConnell, reportedly promised Sen. Susan Collins of Maine that he would support amendments strengthening the ACA in the year-end budget negotiations. But House Republicans, including Speaker Ryan, are strongly opposed to the idea of doing anything to save Obamacare.
Having tried dozens of times to kill the ACA, the House is unlikely to support any resuscitation efforts. Instead, either this year or next, House Republicans will be doing everything in their power to roll back expansion of Medicaid coverage made possible by the ACA.
They still believe, against all polling evidence to the contrary, that they have a public mandate to kill the ACA, no matter the consequences for the poor and those with pre-existing conditions who would lose coverage.
If wrecking Obamacare is part of the "Big Christmas Present" the President promised the American people, it's the political equivalent of coal in our stockings.
But, hey, as the President has said so many times before, he loves coal. It's the thought that counts.
Robert Walker is the president of the Population Institute, a Washington-based organization promoting family planning and the reproductive health of women at home and abroad.
Uncommon Knowledge
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
