Donald Trump has continued to say that he likes the part of Obamacare that doesn't let insurance companies refuse to cover them if they have a pre-existing illness. He says he wants to keep that, and maybe some other things, like allowing children up to age 26 to stay on their parents' plans—again a very popular part of the law. But as New York Times health reporter Margot Sanger-Katz explains, keeping all that and "repealing" Obamacare just isn't that simple.
Those policies that make the insurance market feel fairer for sick Americans who need it can really throw off the prices for everyone else. That’s why Obamacare also includes less popular policies designed to balance the market with enough young, healthy people.
Imagine you’re that patient with cancer. You really want health insurance, and you’re probably willing to pay a lot to get it. If the law requires insurance companies to offer you a policy, you are very likely to buy it.
Now imagine you’re a young, healthy person without any health problems. Your budget is tight, and health insurance is expensive. You might decide you’ll be fine without insurance, since you can always buy it later, when you’re the one with a pessimistic diagnosis.
Before Obamacare, several states tried policies like this, and required insurance companies to sell insurance to everyone at the same price, regardless of health histories. The results were nearly the same everywhere: Prices went way up; enrollment went way down; and insurance companies fled the markets.
The gold standard for polling on Obamacare, Kaiser Family Foundation, makes it clear: the only provisions that actually are unpopular about Obamacare are the things with "mandate" in them—the individual mandate and the employer mandate. And those elements are critical to making the whole thing work, and work affordably. As Sanger-Katz clearly explains: "Taking away those unpopular pieces of the law and keeping the popular pre-existing conditions piece might seem like a political win. But it would result in a broken system."
Insurance companies would balk, premiums for everybody would skyrocket, and millions would drop their insurance. Obamacare is very much a Rube Goldberg-like contraption in which all the moving pieces have to slot together to make the thing happen. Its very complexity is why you can't pick and choose parts of it to take away. Take out one cog, and the thing ceases to function. Which is just fine with Republicans, who don't think further than the fact that they got into office by promising to repeal Obamacare.
It's not going to be just fine with the more than 20 million people who have (mostly) affordable insurance now, but could lose it entirely and be back out in the cold in a year or two. Add on the end of Medicare as we know it, and the very people that put Donald Trump in office won't be so excited about "change" anymore.