OPINION: Repealed, replaced or tweaked, the essence of Obamacare will endure

Jan. 10--Try though they might, Republicans won't be able to erase President Barack Obama's legacy expansion of health care when they take control of the White House along with both houses of Congress.

Oh, sure, it's possible that GOP lawmakers and incoming President Donald Trump will follow through on their frequent promises to get rid of Obamacare -- the Affordable Care Act of 2010, Obama's signature law.

When it was merely an impotent gesture of rage and contempt sure to be blocked or vetoed, Republican members of the House voted some 60 times to repeal or seriously undermine the ACA. Their chance to do it for real is nigh, and Trump pressed Tuesday afternoon for a repeal vote "probably sometime next week."

I suspect they'll chicken out.

Even though poll after poll shows Obamacare as a whole is viewed unfavorably by a plurality of the public, that's basically the result of a relentless GOP effort to exploit the massive law's every shortcoming, every annoyance and every failure.

What don't people like about it? The most recent Kaiser Health Tracking Poll, taken a week after the November election, has the answer:

That it allows children to remain covered by their parents' insurance plans until age 26? That it gets rid of copays for many preventive services? That it creates health insurance exchanges and provides premium subsidies to low-income people? That it helps states expand Medicaid?

No. Those provisions all enjoy at least 80 percent approval ratings.

That it increases the Medicare payroll tax on those with high incomes? That it prohibits insurance companies from denying coverage based on a person's medical condition?

No. Those provisions both enjoy 69 percent overall public approval.

That it imposes a fine on nearly every adult who chooses to remain uncovered by health insurance?

Yes. Only 35 percent approve of Obamacare's coverage requirement. It's the only major portion of the law that polls under 50 percent, and the public would cheer loudly for its repeal.

But you know, reader, just as the Republican politicians know, that the insurance mandate is a key support beam for the wildly popular elements of Obamacare. If young, healthy people opt out of the insurance market, leaving only older, sicker people, premiums rise, companies abandon the exchanges and the whole legislative contraption starts to fall apart, as in some ways it already is.

And if in repealing Obamacare, Republicans cut or eliminate the premium subsidies that make policies affordable for those with low incomes while scaling back Medicaid, an estimated 20 million people would lose their coverage or end up on vastly inferior plans.

As a candidate, Trump promised to replace Obamacare with "something terrific" that would preserve the most popular components, lower premiums and enhance coverage, all while eliminating the mandate. That this was a vaporous and logically inconsistent idea without an actual plan behind it didn't seem to bother his supporters, even those now benefiting from the law.

Other Republican leaders trying to settle on a replacement plan also have run into similar roadblocks: The magic of the marketplace in which they believe so ardently simply won't cover as many Americans as the dreaded Obamacare.

That's why you've seen them start to go wobbly in recent days, clearing their throats, shifting in their seats and talking about delaying repeal until they can come up with a sufficiently robust, politically palatable replacement plan, though Trump doubled down Tuesday on the idea it could be passed "very quickly."

Yes, the GOP has had six years -- generations, really -- to come up with their way of dramatically reducing the numbers of the uninsured. But party leaders haven't really considered such people as the government's problem. Until now.

The political reality is that if the Trump-led GOP majorities end up replacing Obamacare or simply tweaking it, they will have to honor certain principles that the law has embedded deeply in our culture.

Sickness should never bankrupt you. Insurance companies should never be able to deny you coverage or cut you off when your expenses surpass certain limits. Providing low-cost preventive care and keeping the poor out of emergency rooms for routine ailments are socially and economically beneficial.

We're closer than we've ever been to acknowledging that access to quality health services ought to be a right, not a privilege, particularly in a nation that is forever congratulating itself on its singular greatness.

We're closer than we've ever been to a consensus that government, for all its flaws, can and should be the front-line guarantor of adequate medical care for everyone, and that a "Medicare for all" system would more than pay for itself in efficiency and positive health outcomes.

Obamacare, laden with unsatisfying ideological compromises and riddled with vexatious complications though it is, created these new and higher expectations. Obamacare expanded not only the numbers of people covered by health insurance, but also our moral understanding of what decency demands of us.

Republicans can, if they dare, take all 20,000-plus pages of regulations associated with the Affordable Care Act and run them through the shredder.

But they'll never take us back.

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