Repeal, Replace, and Retrench

Repealing the Affordable Care Act and finding an array of substitutes will require work. The process will not always be painless. But sometimes, lawmakers have to look beyond the immediate, lean against the wind and head in the right direction.

The full-throated rhetorical war over the Affordable Care Act has begun. The health care law, also known as Obamacare, will likely meet its demise in the coming days, weeks or months. Given its structural infirmities – soaring premiums and deductibles, collapsing exchanges and CO-OPs, unbalanced risk pools – that would almost certainly have been true under a Hillary Clinton presidency, as well; it just may have taken a little longer.

Obamacare opponents (largely Republicans) repeat their longstanding pledge to "repeal and replace," which the health care law's supporters (largely Democrats) disparage as "make America sick again." Supporters argue that millions gained coverage under the law, and its repeal may deprive them of that coverage. Opponents can truthfully craft a three-part counterargument: 1) the way the law paid for that increased coverage harmed vastly more millions, some severely; 2) the coverage gains that supporters tout may in part be transitory; and 3) there are better ways to expand coverage.

The Affordable Care Act is at best a byzantine zero-sum game with many winners and far more losers. Some gained coverage; others lost coverage (or crucial parts of their coverage). Some felt costs go down; others saw theirs go up. For some, care improved; for others, it deteriorated. The health care law likely means better health for some, worse health for others.

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