Tim McBride: Trump and GOP Face Catch-22 Trying to Alter ACA

Faculty; Policy; Public Health

While President Trump and a Republican-controlled legislature look to make good on campaign promises to repeal and replace the Affordable Care Act, political reality is kicking in, says a health economist at Washington University in St. Louis.

“They face a vicious Catch-22 as they attempt to replace Obamacare,” said Tim McBride, professor at the Brown School and noted expert on health reform, especially Medicare and Medicaid policy.

Trump and his GOP colleagues have promised much: to allow people who secured insurance under the ACA to maintain coverage; to replace the expansion and lower the costs of Medicaid; to eliminate the individual mandate; to leave in place popular provisions and to eliminate all or nearly all tax increases enacted to pay for the ACA.

“By now, most if not all of the GOP members of Congress realize that achieving all of these goals is impossible,” McBride said. “These are huge policy dilemmas the GOP faces.”

For example, McBride said, it is impossible to repeal the taxes enacted to pay for the ACA and have enough money left so that the same number of people are covered by insurance after passage of any reform legislation, because the subsidies in the ACA are what made it possible for the poor and near-poor to afford coverage.

“To cite another example, the stability of insurance markets will be severely strained if the mandate is repealed along with subsidies to buy coverage,” he said.