Around 1:30 AM on Thursday, Republicans began the process of dismantling Obamacare with a budget resolution, which triggers Congress to get moving on repeal legislation and kicks off the grand public health experiment of seeing what happens when twenty million people suddenly don't have health insurance. The resolution passed straight down party lines, 51-48, with Senator Claire McCaskill (D-MO) objecting, "Because there is no replacement, I vote no."
But we shouldn't worry that Republicans will repeal Obamacare and have nothing to replace it with. Oh god no, it's much worse than that.
Republicans are ready to cherry-pick from a Rolodex of bad ideas, ones that promise a race to the bottom for consumer protection and higher costs for people who need health insurance the most. Here are four of them.
The Plan: Sell insurance across state lines Why It's a Bad Idea: Conservative health insurance ideas are ironically pro-choice: They feel people should have a choice about the insurance they have, which will increase competition and lower costs. That's why selling insurance across state lines is a Republican fantasy and a talking point that Trump recited in the second presidential debate: "We have to get rid of the lines around the state, artificial lines, where we stop insurance companies from coming in and competing."
What Trump ignores is that the ACA has permitted sales across state lines since January 2016, allowing states to form healthcare choice compacts. The reason this fact is easy to ignore is that most states aren't interested—only three states have signed them into law since the ACA kicked in. Yet conservatives want to make sales across state lines the rule, not the exception.
Here's how it could collapse a market: If State A says healthcare premiums should be the same for healthy people as sick people, then premiums are sure to be higher than in State B, where regulations aren't as strict and prices are lower. State B would attract young, healthy people who want the cheapest rate possible. In turn, State A's pool would become mostly sick people and their rates would soar, which would scare away more people, raising the costs even higher. "The end result is that we could reach a race to the bottom in terms of regulation, where insurance companies gravitate to the loosest regulations and it would be hard for states to impose any sort of consumer protections," says Christine Eibner, a senior economist at the RAND Corporation.
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