Paul Krugman, the Nobel Prize-winning economist and New York Times columnist, thinks Republicans have boxed themselves into a corner with their attempt to repeal the Affordable Care Act (ACA), better known as Obamacare.
In a series of tweets Thursday, Krugman laid out the political and policy pickles in which the GOP finds itself as it tries to deliver on its years-old promise of repeal, while also maintaining coverage for more than 20 million people who have gained access health insurance through the ACA.
“Watching Republicans trying to grapple with the reality of ACA repeal is both entertaining and deeply dispiriting,” Krugman said. “The entertainment comes from watching them get caught by a trap of their own devising. Their base will punish them if they don’t repeal. But white working-class voters convinced themselves that that nice man Trump wouldn’t possibly take away their coverage.”
Krugman also argued that Republicans have cornered themselves on any substantive policy changes to the health law by accepting the more popular parts of Obamacare.
Trump and other members of the GOP have said they plan to keep some of those provisions, like one that prevents insurance companies from denying coverage based on a preexisting condition.
The only problem, according to Krugman, is that to keep the "good parts," the other aspects - such as the individual mandate - have to stay too.
"To cover preexisting conditions, you need community rating," the economist said. (Community rating forces insurers to charge people in the same location the same premium regardless of health status, gender, and more.)
"To avoid a death spiral from community rating, you need an individual mandate - require people to sign up when healthy. To ensure that everyone can afford to buy insurance under the mandate, you need subsidies. So it has to be regulation+mandate+subsidy. In other words, it basically has to be Obamacare."
The problem, according to Krugman, is that Republicans have been so vehemently against the law for so long that they simply can't back down now that they control Congress and the White House.
"Now, after all that denial, they can repeal at will - and are realizing that 30 million people, half of them [white working class], will lose coverage, and they're terrified of the political fallout," Krugman concluded. "Horrible that they got away with this for so long. Now they should pay the full price."
While more than half of those that have gained access to health insurance from the ACA are white and an overwhelming amount make less than $100,000 as a household, it is unclear how many are Republicans or Trump supporters.
Additionally, much of the fallout comes down to how the Democrats and Republicans sell their plans. Republicans have said Obamacare is simply going to fail on its own anyway, so their changes are more palatable than the "death spiral" in which the law currently finds itself.
Democrats, on the other hand, cite the record number of people signing up for ACA coverage and say the law only needs minor tweaks to make it sustainable without depriving people of coverage.
View Krugman's full tweetstorm below:
Watching Republicans trying to grapple with the reality of ACA repeal is both entertaining and deeply dispiriting. 1/
— Paul Krugman (@paulkrugman) January 5, 2017
The entertainment comes from watching them get caught by a trap of their own devising. Their base will punish them if they don't repeal 2/
— Paul Krugman (@paulkrugman) January 5, 2017
But white working-class voters convinced themselves that that nice man Trump wouldn't possibly take away their coverage 3/
— Paul Krugman (@paulkrugman) January 5, 2017
Meanwhile, the logic of coverage remains what it was all along. To cover pre-existing conditions, you need community rating 4/
— Paul Krugman (@paulkrugman) January 5, 2017
To avoid a death spiral from community rating, you need an individual mandate -- require people to sign up when healthy 5/
— Paul Krugman (@paulkrugman) January 5, 2017
To ensure that everyone can afford to buy insurance under the mandate, you need subsidies. So it has to be regulation+mandate+subsidy 6/
— Paul Krugman (@paulkrugman) January 5, 2017
In other words, it basically has to be Obamacare. But Republicans denied and denied, and voters never got it 7/
— Paul Krugman (@paulkrugman) January 5, 2017
Now, after all that denial, they can repeal at will -- and are realizing that 30 million people, half of them WWC, will lose coverage 8/
— Paul Krugman (@paulkrugman) January 5, 2017
and they're terrified of the political fallout. Horrible that they got away with this for so long; now they should pay the full price 9/
— Paul Krugman (@paulkrugman) January 5, 2017