As expected, the new Republican-controlled Congress has voted to repeal Obamacare - or, at least, as much as they can reach through the budget provisions. They've promised to introduce more bills quickly to replace some of what they can repeal and alter other provisions they can't affect with the reconciliation bill, although exactly what that would look like is still a little unclear.
Needless to say I'm not particularly happy about this.
The best case scenario I can see (at least for one side) involves the Republicans somehow managing to get their block grants, interstate insurance markets, high-risk pools, and insurance-related tax deductions through a Democratic filibuster quickly. (Given the number of people who have painted unhappy visions of a partial repeal, I don't think I need to cover those negatives, and I don't really want to spend too much time on that anyway.)
Even if I grant the assumption that they'll get it through quickly, and if my assumptions about what policies they'll pursue are correct, it still doesn't look good to me. Once insurers actually manage to establish the networks they need in other states (which will not be simple, easy, or quick), then they're just going to find the state with the least comprehensive requirements and operate there. That's fine if you don't need very much coverage... but with the reduction in the market for more comprehensive plans, those prices are going to go up, and many people who need more coverage are going to find themselves in trouble. And I doubt that any high-risk pools will have low enough prices to help, or that any of the incentives offered to offset costs will be anything other than a cut relative to what the ACA offers.
And yes, government spending will also go down... along with the number of people actually receiving assistance from Medicare and Medicaid, or the number of people receiving assistance to obtain health insurance.
So what I end up looking at is less coverage for our money, fewer people being covered, and probably no change in my taxes, since we're in debt either way. I see more people risking their health on more limited insurance, and I think many of them are going to find themselves worse off as a result. I see many people not being covered at all, and I know they'll definitely be worse off.
Somehow it seems just a little bit callous to be happy about those prospects, when my budget can easily survive the increases in taxes or insurance costs that keeping Obamacare would entail.