Repealing Obamacare came up again, briefly but forcefully, in last night's Republican presidential debate. The candidates might want to remember that the Republican Party's own 2012 post-election analysis declared that the GOP needed to do better at showing that it cares about lower-income people and about America's racial and ethnic minorities. Repealing Obamacare goes against these goals.
Obamacare has led to an historic increase in health insurance coverage for low- and moderate-income Americans. Republican plans for health insurance reform will likely cover fewer people, provide fewer benefits to low-income individuals, and possibly increase the federal deficit. This is the wrong direction for the country.
A couple weeks ago, Republicans in Congress demonstrated that they have the power to repeal Obamacare if a Republican is elected president. All of the current Republican candidates for president are committed to this goal. Donald Trump calls Obamacare a "total catastrophe." Senator Ted Cruz says Obamacare is a "horrible experiment [that] has failed." Senator Marco Rubio states, "Obamacare has revealed the painful consequences of placing our faith in big government." They all have vowed to repeal it if elected president.
But the Census Bureau reports that the disadvantaged communities targeted by the Republican Party for outreach had the biggest gains from Obamacare. From 2013 to 2014, by income, households earning less than $50,000 a year increased their health insurance coverage by more than four percentage points while people overall saw an increase of less than three percentage points. This development is beneficial since these households had (and still have) higher uninsured rates than average. Putting low-income Americans' health insurance at risk or replacing it with inferior plans is not a way to convince them that the GOP cares about them.
My analysis of the Census data shows that Obamacare had historic success among America's racial minorities. From 2013 to 2014, the uninsured-rate disparity between black and white children and between Asian Americans and whites was essentially eliminated. It is rare for a racial gap to be closed, but Obamacare has done so while improving health insurance coverage rates for all racial groups.
The Affordable Care Act has also done well in reaching white lower-income populations in the states that expanded Medicaid under the Affordable Care Act. Kentucky, West Virginia, and Oregon had the largest increases in health insurance coverage among whites due in no small part to increases in Medicaid coverage. More whites as well as non-whites would benefit if all states expand Medicaid.
Of course, Obamacare is not perfect. There are reports that many low-income and moderate-individuals find the premiums and deductibles too expensive. Republicans have ideas to lower costs, but it appears that their favorite method is simply to reduce health benefits. This is far from the ideal solution. Many of our closest international allies have lower per-capita health care spending and provide coverage to a larger share of their population. America is definitely not number one in providing health care. The United States should learn from its international friends.
Rather than insist on repealing and replacing Obamacare, the Republican Party should embrace it. After all, it is essentially a Republican idea. The White House has acknowledged that Mitt Romney's "Romneycare" was a model for Obamacare. Health policy experts are aware that Obamacare is the child of Romneycare. Even Mitt Romney noted, "Without Romneycare, we wouldn't have had Obamacare." (And then he retracted his statement.)
If Republicans claim Obamacare, they could then claim that the historic increase in health-insurance coverage among low-income people and among people of color is due to what is fundamentally a Republican policy. This would be a big step forward in the post-election outreach that they declared was a priority.