President Trump needs to make a dramatic change if he is to act optimally wise with respect to bringing about passage of legislation that changes America's health care system away from the Affordable Care Act and significantly for the better! One theoretically possible outcome on this whole issue is that the Republicans draft replacement legislation that becomes law because it garnishes eight Democrat Senators votes to overcome the Democrat Senate filibuster that would definitely come on such a bill. But I think the odds of that happening are practically nihl because that would require the legislation to give tax credits and/or vouchers in the amount needed by those Americans that need financial help getting health insurance because of insufficient income which the ACA does and the Republicans will not propose such costly legislation it is too adverse to their thrifty character. I don't often agree with the editorial writer E. J. Dionne because his politics are left wing and mine are center right but he recently wrote an article on the ACA where he was spot on about the whole Republican campaign against the ACA what he said and I am paraphrasing here is that all the Republican criticisms on the ACA like that it creates big government and it violates the reality that if you like your plan you can keep it is all smoke and mirrors, "happy talk" as he puts it, what the Republicans are about at the core of their campaign is that they do not want to financially help at the levels needed those Americans that need help getting health insurance because of their insufficient incomes because it means raising revenue which means raising someone's taxes and Republicans hate raising taxes they don't fully recognize the principle that the government has a duty to help these Americans that access to affordable health care for those working or who have a legitimate reason for not working facilitate is a fundamental right in a good society and fulfilling this duty like fulfilling many other government's duties requires raising revenue and therefore requires issuing and/or increasing a tax. Odds are this Republican Congressional effort to create a replacement law will not create a good one because the legislative process that seems to be being used is not a responsible one, they seem to be poised to quickly draft the law in committees with little or no hearings and push it onto the Chamber floor for votes, a rushed cut-corners process; a responsible one would have numerous committee hearings with participants in the health care industry seeking to determine the effects of the law identify problems in the resulting system and seek to solve these problems. One option President Trump could take with this obvious development that seems poised to unfold is he could say to the Republican Leadership in Congress I will sign "repeal" legislation we can make the effective date of repeal two, three or five years out so that there will be time enough to enact a replacement law so people that have insurance through the Affordable Care Act will not be hurt when it goes away and locking in the repeal will put pressure on Democrats to cooperate in passing replacement legislation. Critics that say the Republicans cannot repeal the ACA with only majority support in Congress would be absolutely wrong the Republicans can hurt the ACA sufficiently enough that it will collapse the whole system through the Congressional "law passing" system of reconciliation which only requires majority vote for passage of legislation affecting the federal budget; one example where the Republicans could use this to a decimating effect is if they used the reconciliation process to repeal the ACA insurance voucher program that helps American families with incomes up to four times the poverty rate buy health insurance on the exchanges doing this would largely drive these families off the exchanges leaving the exchanges with small pools of insurance enrollees who would be largely Americans with serious pre-existing health conditions resulting in sky-rocketing premiums that would be unaffordable resulting in the system collapsing. President Trump could also largely do it by Executive Order through Executive Order he could waive any penalty that essentially forces people to buy Health Insurance on the exchanges thus reducing the size of the exchanges' pools through executive order he could reduce marketing of the exchanges and make the voucher program more rigorous dramatically hurting participation and through executive order direct the corresponding federal departments in various areas to construe the ACA law in a manner most adverse to facilitating insurance companies participation on the exchanges already now there is only one insurance company on the exchange for hundreds of counties across America if no insurance is offered on the exchanges for these or other counties that is a de facto repeal for these Americans. President Trump would be making a catastrophic mistake that would have a devastating impact on his administration if he either signs into law legislation that repeals the ACA without a concurrent replacement law or repeals the ACA through Executive Order before Congress passes a replacement law! If the Republicans repeal the ACA law without concurrently replacing it with a good law Democrats are going to dig in their heels against helping pass any replacement law the replacement law would not only have to not only be truly good but have no significant drawbacks at all for it to get any Democrat support and without Democrat support you don't get past the Senate filibuster and you don't get any replacement law. What the situation will be like is remember back in 2012 when President Obama said if I win the 2012 election I am going to issue an Executive Order giving a temporary visa to a massive number of illegals and the Republicans said you do that President Obama and we will not work with you on passing comprehensive immigration reform and President Obama went ahead on his plan on the Executive Order and the Republicans in Congress carried out their threat to not work with him on the legislation. The facts are Minority Leader Senator Schumer has already issued this threat President Trump would be a complete fool to believe he would not carry it out Senator Schumer is an old veteran of countless Senate battles over the decades if he makes a threat a prudent person would take it as a given he will carry it out. Another compelling reason for President Trump not to move to repeal the ACA without a replacement would be what the effect such a move would have on the 2018 and 2020 elections such a repeal with no replacement move would create ten plus million scared and angry Americans who currently get their health insurance through the ACA and will be losing it through this Republican move good judgment would conclude they would be voting Democrat to get this ACA benefit restored. Another reason for the Republicans not to do a repeal without a replacement move is doing so will unleash a public discourse firestorm of mammoth size against Republicans Americans will be inundated from the news channels and programs with commentators condemning the Republicans for this extremely inconsiderate move there will be an abundance of public protests against the Republicans from a political popularity standpoint for the Republicans it will massively hurt them! President Trump should choose to see this situation clearly what America has is they have a health care system the ACA that the majority of Americans dislike and they have the Republican Party offering a health care system that the majority of Americans at this point dislike, what President Trump should conclude is that this situation calls for the infamous wisdom of Solomon command the baby be cut in half "so to speak" call for legislation to be passed that allows a state through the approval of their legislature with the Governors consent to opt out of the ACA system and they can operate under the Republican Party system with no penalty on individuals if they don't carry insurance no penalty on employers that don't provide Healthcare no exchanges no expansion of Medicaid, block grant Medicaid, the whole nine yards on what the Republicans want. Why should eight Senate Democrats agree to this legislation so it becomes law. To use my manner of speaking they should do it because it is in the best interest of the American people to do it because it is in the best interest of the American people to improve the ACA and this effort won't be fully embraced by the American people until it is clearly shown to them that the Republican system sucks much worse than the ACA system. To put it another way there is a lot of responsible ways to improve the ACA system but Congress and the President will never get around to fully pursuing this effort through legislation when they believe there is a better framework for America's health care system out there, the only way to prove there is no better system is by letting the "throw the system out" critics have their way green light their efforts in some states with the proviso that these state governments will have the power to protect their people when the Republican plan is shown to be overall worse by opting back into the ACA system. These Democrat Senators should remember there is a lot of ways to improve the ACA and this is the only way for the country to get to this improvement focus state. The principle humongous problem with the ACA is that the benefit costs for the average enrollee is so high for the insurance companies which they obviously pass on in yearly premium increases to the American people. The Democrat Party has already proposed a good savings idea in this area which is allow older Americans that are close to the Medicare eligible age who because of their older age are generally the sickest and thus the costliest for the insurance companies operating in the exchanges to buy into Medicare which will get them out of the exchanges. Another proposal which is rather an obvious one is based on noting how many families if they really needed to could pay more than the out-of-pocket cap of $14,000/year mandated by the ACA why not change the law requiring the insurance companies to offer the cap as a rider where the companies would be required to offer three riders a cap at $14,000 one at $28,000 one at $56,000 and of course the ACA would mandate those Americans getting vouchers get the $14,000 cap rider - this would lower premium costs for people on the exchanges not getting voucher subsidies that chose a higher cap. If someone was charged to predict the future on this issue I think logic calls for the following analysis. The ACA was enacted into law in 2010 and from day one the Republicans were vehemently condemning the law and saying we can do better and for seven years now they haven't drafted a better law. Logic calls for the conclusion that these four Congressional committees charged with drafting the Republican's replacement law are not going to produce a better law the Republicans will make a great show of it but overall the replacement law will leave too many Americans on the side of the road and for that reason won't get the eight Democrat Senators votes needed for passage and will die in the Senate. Based on the aforementioned analysis wisdom calls for President Trump to have a powwow with Speaker Ryan and Senate Majority Leader McConnell and say I don't want to be the head of the political party that for seven years has vehemently complained that the 2010 health care law is a great scourge on our nation and after being given the White House and both chambers of Congress by the American people fails in providing relief from this law for the American people so I want you to do the following. For the health care bills in the committees and the ones that go to the floor in your chambers I want you to have two major sections one section will be a replacement law for the ACA and the other section will be an improvement law for the ACA now you can direct the Chairpersons of these committees that they will facilitate the creation of the section that improves the law and if your Chairpersons don't cooperate or do a bad job you will ignore their bill and in the bill you send to the floor you will have a good improvement section because you have the power to do this. Now during the amendment process protect the ACA improvement section of the bill and to Senator McConnell when it comes close to the end of the amendment process determine if you have the sixty votes needed to overcome a filibuster on only the replacement section if you do amend the bill to discard the improvement section and pass the replacement law and if you don't have the sixty on the replacement bill try to get it on the improvement bill if you get on the improvement bill discard the replacement bill and pass the improvement bill; Speaker Ryan then try to mirror whatever the Senate does on your Chambers bills. The rest of the process I don't need to comment on because you know how to do it. President Trump should tell them don't pursue doing a replacement bill and after that fails likely in the Senate go back and do an ACA improvement bill because there won't be enough time and will amongst the rank and file to do a high quality job and most importantly the will to take the hard votes that will be needed to pass a major improvement bill. President Trump should tell them the only restriction he has on the improvement bill is no tax raising because if you allow tax raising the Democrats will make a continuous scene calling for a government sponsored healthcare provider for the exchanges which is a colossally stupid idea that would essentially "eventually" drive all insurance providers out of the health care insurance industry leaving America with only this government sponsored health insurance provider with its ultra low mandated fees for health care providers resulting in limited availability of health care providers and a lot of low quality health care providers, a terrible development for the American people. Democrats would be prudent to really cooperate on improving the ACA if that option is offered to them what I am referring to here is cooperate in revisiting the laws mandates to change them to lower the cost of care per enrollee per year on insurance providers so they can pass that on to enrollees to put it another way improve the cost controls in the law. Democrats seem to banking on their key two-part fix for the ACA which they describe as raising more federal revenue and sending that into the system to lower premiums and out of pocket costs for Americans and secondly to create a government sponsored health insurance provider to offer Americans choice on the exchanges. The first part of the Democrat fix is like a dog chasing his tail they will never succeed they might for a short period of time but if they don't stop the yearly ballooning costs for insurance issuers on the exchange the federal government will never continually catch up with raising the revenue needed to keep premiums and out of pocket costs in the good range. For the second part, that is an enormously costly undertaking that over the long term will only be able to be managed by empowering through law this government sponsored insurance issuer being able to pay health care providers Medicare rates resulting in private insurance issuers and employer sponsored health insurance issuers not being able to compete and stopping offering insurance which as stated above will essentially put everyone into this government sponsored insurance program with long-term bad consequences. Democrats would be wise to recognize that if not immediately definitely over the medium to long term a lot of their base will abandon them on this issue they will not think this is the correct course for America to be on, namely in part, because a lot of their union base and a lot of their upper and middle income base will understandably not compromise on their requirement of having good quality health care readily available for them and their families! ​
Democrats realize that the Republicans are about to own healthcare in America and they are too smart to get in the middle of a potential Republican fiasco. The Republicans screwed America for eight years and blamed Obama and now they are squirming like the worms they really are. The Republicans left America to suffer and rode the healthcare crisis to power and now they are going to own the mess they created. It would be fun to watch if it weren't for the fact that the American people are the victims when the political parties play their silly games.
