My Crystal Ball Reading for Obamacare

January 4, 2017, 1:35 PM UTC

This essay appears in today’s edition of the Fortune Brainstorm Health Daily. Get it delivered straight to your inbox.

Good morning. The battle over the battle of Obamacare repeal comes to a sort-of head today as both President Obama and Vice President–elect Mike Pence march to Congress to shore up their respective troops. The pep talks won’t change much. Like some staged Civil War reenactment, both sides will initially hurl themselves at each other with their rhetorical Bowie knives and revolvers. But the real fight will almost certainly slog on for months, as Kelsey Snell and Mike DeBonis have reported in the Washington Post.

In terms of procedure, one oft-mentioned strategy is for Republican Congressional leaders (who have only a slim majority in the Senate) to use a convoluted parliamentary workaround called “budget reconciliation” to strip away the financial circuitry and plumbing of the Affordable Care Act, even as they leave the legislative framework standing. Think of that approach as marauders rushing into a new construction project and absconding with all the electrical wiring and copper pipes.

But there have been increasing cries—including late yesterday from the American Medical Association, the influential guild for U.S. physicians—not to dismantle the existing, if flawed, Affordable Care Act before settling upon a replacement. Even some diehard Obamacare antagonists, such as Sen. Rand Paul, have upped their warnings about killing the nearly seven-year-old legislation in piecemeal fashion without having a full substitute at the ready.

So what would that replacement look like? Well, let me grab my crystal ball.

Hmm, I see something….faint, but ah yes, it’s becoming more clear. There’s a bill—many months from now. It makes sure not to pull the rug out from the 20 million or so Americans who have gotten health insurance under the ACA. (They have to have coverage of some kind, of course.) And this bill keeps the provisions that Donald Trump says he wants to keep—and that millions of American voters want to keep—like those that prevent insurers from blacklisting people with preexisting medical conditions and that allow parents to include their slacker twentysomething kids on their own policies. And natch, this legislation has mechanisms that makes sure there’s an intact marketplace of insurers, and that people aren’t freeloading off of the hefty premiums paid by hardworking Americans: This is a conservative plan, after all.

Sure, some will scoff and say it looks an awful lot like Obamacare. But it’s nothing like it. This bill, for instance, has a rock-ribbed Republican name. Yes, I can see the letters getting sharper now in the crystal ball: Freedom-care.

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