President Trump and our Republican controlled congress have promised to quickly repeal and replace ObamaCare.  President Trump says that coverage will be better, cost will be lower, and everyone will be covered.

We should consider where we were before ObamaCare and where we are today as a basis for judging proposed replacements.  Using the years 2004 – 2009 as a baseline for how we were doing before ObamaCare and 2010 – 2015 as a measure of its effectiveness, here are some facts.

Each of the following statistics is for five years of change before and after ObamaCare.   All spending is inflation adjusted to 2010 dollars.

• The five year increase in healthcare spending by government (federal, state and local) declined after passage of ObamaCare from 19.5 percent to 12.3 percent.
• The five-year increase in private expenditures grew from 6.5 percent before ObamaCare to 7.8 percent.  Much of that growth represents insurance premiums for previously uninsured individuals.
• The five-year increase in total healthcare spending declined after passage of ObamaCare from 12.3 percent to 9.9 percent.
• Total health care spending grew 1.9 percent faster than our Gross Domestic Product in the period before ObamaCare.  In the period following passage it grew one half of one percent faster than GDP.
• Prior to ObamaCare, the number of Americans who were uninsured was growing every year.  It peaked at 48.6 million in 2010.  After five years of ObamaCare, the number of uninsured was down to 28.6 million, the lowest number since we began keeping records.

Below is similar cost data from a different source and a link that will allow you to browse a wealth of relevant information.

Evaluate performance data from the US and other developed nations HERE using tools developed by the Organization for Economic Cooperation and Development.

Some other changes brought about by ObamaCare are:

• Before ObamaCare, important screenings like colonoscopies and mammograms were unaffordable for many people.  Now they are covered without deductibles.
• Insurance companies and employers can no longer deny coverage or charge more for pre-existing conditions.  Previously, cancer survivors, diabetics and others likely to need expensive care were uninsurable on most family budgets.
• Lifetime limits on coverage were banned.
• Mental health services are covered on the same basis as other medical and surgical services
• Dependents can stay on parents’ coverage up to age 26.

ObamaCare is a success compared to what we had before it passed.  But health care costs are still rising faster than our economy is growing and we still have over 28 million uninsured Americans so more improvement is needed.

The ObamaCare insurance exchanges where individuals and small employers should be able to purchase affordable coverage are not consistently working well .  Millions of young, healthy Americans are not buying coverage as required by the law.  That leaves a disproportionate number of unhealthy and older people in these insurance pools.  In markets where that has happened, premiums have risen at double-digit rates and several insurance companies dropped out, leaving meager choices for consumers.

That problem leads directly to critical questions about replacing ObamaCare.  Will congress decide that it’s acceptable for some Americans to have no health benefits?  If everyone is going to have benefits, is there a less expensive alternative than Medicaid expansion?  If so, will it be included in the Republican replacement for ObamaCare?  If not, will it then be acceptable for doctors, hospitals and other health care providers to deny services to those who can’t pay?  To be very clear to free market friends, “There ain’t no such thing as a free lunch.”  If the ObamaCare replacement does not include a way to pay for care of the uninsured then either they will die without care or the cost will be built into your bills and insurance premiums.

There are proven ways to provide more care for less money while covering the entire population.  Every other developed nation has adopted one of them and they are all more cost-effective than ObamaCare.  They range from price controls to “medicare for all” or government operated health care similar to the British model.  All of them require a larger role for government and that seems to be the antithesis of Republican thinking.  President Trump said that no one should be required to buy health insurance.  At present it appears that he intends to provide something (health care) for everyone without requiring anyone to pay for it – a miracle of biblical proportion.

We can hope that the post-election hostility will wane in favor of intelligent consideration of how to replace or improve ObamaCare. It can be done if legislators and the President are willing to forego political rhetoric for what is practical.  If they are not, then both human and economic catastrophes are likely.