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peaking at a campaign-style rally in Michigan last week, President Trump declared Obamacare dead. “Essentially, we are getting rid of Obamacare… . Some people would say, essentially, we have gotten rid of it.â€Um, no. Whatever those mysterious “some people†might think, not only is Obamacare still with us, but its problems are getting worse.What the president was likely referring to was the health-care law’s much-despised individual mandate, the requirement that every American purchase health insurance or pay a penalty, which was repealed as part of the tax-reform bill. But while the mandate was always the most unpopular part, it was never the structural heart of the Affordable Care Act.In many ways, Obamacare’s original sin is its requirement that insurers cover people with pre-existing conditions without charging them premiums commensurate with their costs. By trying to shoehorn people who are almost by definition uninsurable into the traditional insurance markets, Obamacare undermined and destabilized those markets — risking what actuaries call an adverse-selection death spiral, in which the sick are increasingly likely to purchase insurance, while the healthy drop out of the market . . .. . .Repealing the individual mandate was, on the whole, a good thing, because mandating that Americans buy a specific government-designed product is deeply antithetical to the concept of individual liberty that is the heart and soul of the American experiment. But by repealing the mandate without reforming or repealing the rest of the health-care law, Republicans have probably sped up the law’s downward actuarial spiral . . . President Trump didn’t quite fly onto an aircraft carrier beneath a “Mission Accomplished†banner, but his declaration of victory is every bit as premature. Unfortunately, Obamacare is likely to be with us for some time to come. The president and congressional Republicans failed to repeal and replace the Affordable Care Act. And no amount of sugar coating can disguise the fact that Americans will continue to pay the price for that failure.
