The ACA: Love it or hate it, you now have to deal with it

Jon Cohn put it best:

I’ve waited more than two years to write this sentence: The Affordable Care Act is here to stay. It survived the Supreme Court and now it has survived the threat of a unified Republican government determined to repeal it. Implementation of the law will present huge challenges, but, for the first time in a long while, the administration and its allies can focus on those challenges rather than on rearguard political fights to keep the program alive.

There will be no repeal. Of course none of this means that the law is now loved by all. Far from it. Some people believe it is not the way to reform the health care system. Some people have other ideas. And, you know what, some of those ideas are just as worthy and deserving of a trial as those in the ACA. Premium support of a type, more consumer directed health care of a sort, different strategies for Medicaid and Medicare reform: they’re still worth considering. But wholesale repeal and replace with the most conservative version of all of this is not, because it won’t happen any more than will national single payer. We’re not on that train, or not yet anyway. The next stop is the ACA.

The only realistic, if still uncertain, way forward for those who find flaws with part or all of the ACA (and I am among them) is to argue for incremental change. Instead of repeal and replace, consider revise and rework. I don’t expect the political climate to change such that this suddenly becomes easy. Repeal may be dead, but Kumbaya is not alive.

Still, for the good of the country and those who need and deserve better and more affordable health care, we really ought to try. The people have shown us that we’re a long way from Waterloo. Isn’t it time we all started acting like it?


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