EDITORIAL: Battles over Medicare, Obamacare will define 2017

Dec. 04--Republicans in Washington have bashed the Affordable Care Act, aka Obamacare, for six years since its original passage and have vowed to repeal it. Now, they have a GOP president-elect in Donald Trump and will retain control of both houses of Congress. Legislators will have to try to undo the law -- and are already finding it may not be easy.

One reason is that Americans' views of the controversial law are more nuanced than they may appear. A recent survey by the Kaiser Family Foundation found that 30 percent of people want to expand the law and 19 percent want to leave it as is. Only a quarter of respondents want a full repeal. Many Republicans are not anxious to remove more than 20 million people from coverage, with no backup plan, which would surely be bad optics. They are also conscious that, at least in the Senate, they may need some support from Democrats to advance an alternative. This has led to talk of "repeal and delay," a three or so year plan that would phase out Obamacare and phase in a new program.

The notion that Obamacare could live on after 2017 will cause grumbling among Republican base supporters. But a deliberate go-slow approach could prove best for the country, in the end.

Even a new law would wisely preserve several Obamacare provisions, if Trump -- whose tone on the law has softened since the election -- and some Republicans get their way. These include provisions such as allowing children to stay on their parents' plans until age 26, requiring insurance companies to take patients with pre-existing conditions, and preventing companies from dropping patients when they get sick.

However, the individual mandate requiring that Americans purchase insurance or face a fine seems marked for death. This raises a sticky issue for GOP budget writers: How to pay for their plan? Among ideas being floated is a long-standing GOP dream to allow insurers to compete across state lines.

As if the impending Obamacare rewrite is not enough, Speaker of the House Paul Ryan intends to lead a large elephant into the room. He has revived plans to reform the popular Medicare program for seniors, which he'd like to see turned into a private program involving vouchers or what he calls premium support. Ryan has made clear he is going to tie problems with Medicare to Obamacare, a tactic Democrats will resist as they portray Republicans as "throwing granny off the cliff."

A wild card in all this drama will be Trump, who said on the trail he would not touch entitlements. Either way, health care battles in 2017 are shaping up to be epic, and how they'll wind up is anybody's guess.

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