Does the health care industry love Obamacare enough to fight to save it?
The liberal website Vox asked that question and interviewed 20 industry lobbyists to answer it. What the interviewers discovered is not surprising if you've been following the debate over Obamacare for the last seven years.
The health care industry killed Hillarycare in the 1990s and cut deals to shape Obamacare more to its liking in 2009. But now, as Republicans push a sweeping and widely reviled health bill through Congress, the industry has often appeared declawed in the biggest health care fight of the decade.
It's a deliberate strategy, interviews with nearly 20 lobbyists and other experts suggest. Health industry groups generally don't love Obamacare enough to jeopardize their ability to shape the rest of the Republican agenda – including big corporate tax cuts. They also fear incurring White House retaliation.
The Trump administration has already leveled direct threats to cut off federal subsidies to health insurers, to go after the drug industry, and Republicans hold the purse strings for the federal programs that cover many of the patients seen by the nation's doctors and hospitals.
Further complicating matters, different sectors within the industry have very different stakes in repealing Obamacare and replacing it with the GOP's plan. Many health insurers are already ambivalent about Obamacare and could see significant tax cuts if the law is rolled back. Doctors and hospitals, on the other hand, could face a surge in uninsured patients if millions fewer Americans have health coverage.
As a result, those groups have not collectively gone all-out, on the airwaves or in the halls of Congress, to stop the GOP's health care bill – even though they have expressed almost unanimous opposition to it.
"It's not all-out warfare," said Kim Monk, who tracks the health care debate in Washington for investors at Capital Alpha. "Republicans are going to be around for a while, and they tend to be your allies on really important things."
The House legislation is projected to lead to 23 million fewer Americans having health insurance in 2026 and include an $830 billion cut to Medicaid, the nation's largest insurer and a critical safety net for the most vulnerable Americans – and, also, an important source of revenue for hospitals and doctors.
By the way, those numbers come from the notoriously unreliable Congressional Budget Office. And they're based on the GOP House bill, which will be substantially altered by the Senate before the entire bill goes before the president.
But the sentiment in the industry – health insurers, doctors, hospitals, Big Pharma – has always been either ambivalent or opposed to Obamacare. Even the insurance companies, whose support was vital for passage in 2010, have now changed their minds and are abandoning the state exchanges in droves.
They were promised millions of captive customers – consumers forced by the government to purchase their products. But they were also promised that most of the new customers would be "young invincibles" – healthy Americans between 18 and 35 who would jump at the chance to purchase cheap, subsidized insurance.
It was never to be, as younger Americans refused to pay for insurance coverage they didn't need. So most of the sign-ups for Obamacare have been older, sicker Americans who have caused company costs to skyrocket, leading to massive increases in premiums, which forced more customers to drop their coverage. The Obamacare meltdown was predicted from the beginning, and the insurance companies are now paying for their shortsightedness.
Doctors were dubious about the millions of new Medicaid customers under the expanded program. They were already getting paid about half of what it was costing to treat patients, so a large percentage of doctors simply refused to take on any more Medicaid clients.
Drug companies, with stifling new regulations and big tax increases, were the least enthusiastic sector of the health care industry that supported Obamacare. They will look forward to its destruction..
The bottom line is that it will take years to undo the damage done to our health care industry by Obamacare, and many sectors of that industry can't wait to get started.